Anaphylactic Reactions in the Emergency Department of a Portuguese Tertiary Hospital: Clinical Characterization and Disease Notification

Introduction: Anaphylaxis is significantly underdiagnosed, and the medical community’s knowledge about it is precarious. The aim of this study is to characterize the patient population and the Emergency Department approach of anaphylaxis.Material and Methods: Retrospective study of adult patients attending the Emergency Department of a tertiary care Portuguese hospital, over a year, with anaphylaxis. Data were obtained from each patient’s clinical records and anonymized. A questionnaire evaluating knowledge about the notification of anaphylaxis was applied to Emergency Department physicians.Results: The study included 69 patients. Cutaneous (97%) and respiratory features (80%) were most prevalent; 22% of patients presented with shock or related symptoms. There were no reported biphasic reactions or deaths. The likely allergen was identified in 73%, most commonly food; 12% of reactions were related to a previously known allergen. Epinephrine was administered to 15%. Referral to an Immunoallergologist was done in 36% of patients, and 10% received or already possessed an epinephrine autoinjector. Among six parameters recommended for auditing clinical practice, 70% of cases fulfilled less than half. Only 13% of physicians knew it was mandatory to register all cases in the Portuguese Catalogue of Allergies and Other Adverse Reactions, and only 4% knew how to do it; regarding notification to the National Authority of Medicines and Health Products results were slightly better.Discussion: Many patients with anaphylaxis present to the Emergency Department every year, and their clinical approach is not in agreement with national guidelines. Conclusion: An educational program to increase medical awareness of the national guidelines and mandatory notification of all anaphylactic reactions should be implemented.

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The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study

Emergency Medicine International ◽

10.1155/2021/9590859 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ayalew Zewdie ◽

Dejene Tagesse ◽

Selam Alemayehu ◽

Tesfaye Getachew ◽

Menbeu Sultan

Keyword(s):

Emergency Department ◽

Success Rate ◽

Endotracheal Intubation ◽

Addis Ababa ◽

Tertiary Care ◽

Tertiary Hospital ◽

Rapid Sequence Intubation ◽

Care Hospital ◽

Success Rates ◽

First Pass

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

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Impaired Consciousness in the Emergency Department

European Neurology ◽

10.1159/000495363 ◽

2018 ◽

Vol 80 (3-4) ◽

pp. 179-186 ◽

Cited By ~ 3

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.

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Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

CJEM ◽

10.1017/cem.2014.72 ◽

2015 ◽

Vol 17 (4) ◽

pp. 353-358 ◽

Cited By ~ 5

Author(s):

Julian J Owen ◽

Niv Sne ◽

Angela Coates ◽

Peter K Channan

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Survival Rates ◽

Penetrating Trauma ◽

Trauma Centre ◽

Trauma Patients ◽

National Guidelines ◽

Emergency Department Thoracotomy ◽

Life Saving ◽

Record Review

AbstractObjectiveEmergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines.MethodsRetrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge.ResultsOver a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines.ConclusionsSurvival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications.

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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

BMC Public Health ◽

10.1186/s12889-020-10082-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Hospital ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Number Of Visits

Abstract Background Asylum-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. Methods We 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. Conclusions Hospital 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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Health care provided to asylum-seeking and non-asylum-seeking paediatric patients at a Swiss tertiary hospital

10.21203/rs.2.19022/v1 ◽

2019 ◽

Author(s):

Julia Regina Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional ◽

Admission Rates ◽

Number Of Visits

Abstract Background & Methods To compare health care provided to asylum-seeking and non-asylum-seeking children, we performed a cross-sectional study in a paediatric tertiary care hospital in Switzerland. Patients were identified using administrative and medical electronic health records from January 2016 - December 2017. 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%) patients. The emergency department had 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. Hospital admissions were more common in asylum-seeking patients 11% (184/1674) and 7% (14’692/200’642). Frequent visits 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. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients and was less frequently used in asylum-seeking children. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that asylum-seeking patients may present with more complex diseases.

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An observational study on the surgical antibiotic prophylaxis in the surgery ward of a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192665 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1647

Author(s):

Aditi A. Kudchadkar ◽

Sushama A. Bhounsule

Keyword(s):

Observational Study ◽

Antibiotic Prophylaxis ◽

Tertiary Care ◽

Tertiary Hospital ◽

Antibiotic Prescribing ◽

Care Hospital ◽

National Guidelines ◽

Surgical Prophylaxis ◽

Significant Burden ◽

Surgical Antibiotic Prophylaxis

Background: Surgical site infection (SSI) is the most common postoperative complication and represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. Appropriate antibiotic prophylaxis helps in reducing the incidence of SSIs. Appropriate surgical prophylaxis is a multifactorial process that depends on proper case selection, antibiotic selection including dosing and route of administration and duration of therapy.Methods: A prospective observational study was conducted over 3 months on 200 operated patients in surgery ward of a tertiary hospital. Patient details like demography, type of surgery performed and antibiotics prescribed pre and post-surgical procedure was collected and analysed using Microsoft excel.Results: Out of 200 patients 32.5% (65) were females and 67.5% (135) were males. Total number of prophylactic antibiotics prescribed were 368. The most commonly prescribed group of antibiotics was cephalosporins (44.29%) followed by metronidazole (26.5%) and ofloxacin (9.48%). Among the cephalosporins the most commonly prescribed was cefuroxime in 82 patients (50.3%) and cefoperazone in 79 patients (48.46%). SSI developed in 3 out of 200 patients (1.5%).Conclusions: There is an urgent requirement to promote rational antibiotic prescribing among surgeons. The need of the hour is developing and implementing national guidelines for surgical prophylaxis by a multidisciplinary group of experts.

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Indications for destructive eye surgeries at tertiary care hospital, eastern Nepal: A five years experience

Health Renaissance ◽

10.3126/hren.v13i3.17964 ◽

2017 ◽

Vol 13 (3) ◽

pp. 161-168 ◽

Cited By ~ 1

Author(s):

Poonam Lavaju ◽

BP Badhu ◽

S Shah ◽

P Upadhyaya

Keyword(s):

Sebaceous Gland ◽

Ocular Trauma ◽

Tertiary Care ◽

Tertiary Hospital ◽

Ocular Infection ◽

Care Hospital ◽

Female Ratio ◽

Eye Surgery ◽

Open Globe ◽

Clinical Records

Background: Destructive surgery is the management option offered to patients when further retention of the globe is unlikely and can affect ocular and general morbidity.Objective: To determine the frequency and indications for destructive eye surgeries in patients attending a tertiary hospital, Eastern Nepal.Methods: A retrospective analysis of clinical records of all the tructive eye surgeries from April 2008 to March 2013 at a tertiary hospital, Eastern Nepal was carried out. Patients' history, demographic characteristics and indications for the procedure were studied.Results: A total of 88 eyes of 88 patients, who had undergone destructive eye surgery, were reviewed. The mean age of the patient was 22.89 ± 23.49 years, median 9.5 years, with a range of 1.5 months to 80 years. Male: Female ratio was 1:1.04. Enucleation was the most common surgery performed in 46 eyes (52.3%), followed by evisceration in 30 eyes (34.1%) and exenteration in 12 eyes (13.6%). The destructive eye surgery in our study accounted for 51% neoplasms, 17% ocular trauma, 15.9% ocular infection, 10.2% anterior staphyloma and 5.7% painful blind eye. The most common indication for destructive eye surgery was enucleation (60.8%) for retinoblastoma followed by evisceration (46.6%) for open globe injury and exentration (33.3%) for sebaceous gland carcinoma.Conclusions: Enucleation was the most common destructive eye surgery performed. Retinoblastoma, ocular trauma and sebaceous gland carcinoma were the most common indications for destructive eye surgery.Health Renaissance 2015;13 (3): 161-168

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients at a Swiss tertiary hospital

10.21203/rs.3.rs-22231/v1 ◽

2020 ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Hospital ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Admission Rates ◽

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 Switzerland. All patients and visits from January 2016 to December 2017were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed at the reception desks and the patients allocated accordingly in the two study groups.ResultsA total of 202’316 visits by 55’789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%). The emergency department had 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. Hospital admissions were more common in asylum-seeking patients 11% (184/1674) and 7% (14’692/200’642). Frequent visits 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.Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that asylum-seeking patients present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

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Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

CJEM ◽

10.1017/s148180350001352x ◽

2006 ◽

Vol 8 (02) ◽

pp. 85-93 ◽

Cited By ~ 15

Author(s):

Sam G. Campbell ◽

Kirk D. Magee ◽

George J. Kovacs ◽

David A. Petrie ◽

John M. Tallon ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Case Series ◽

Tertiary Hospital ◽

Procedural Sedation ◽

Procedural Sedation And Analgesia ◽

Patterns Of Use ◽

Significant Difference ◽

Sedation And Analgesia ◽

Pharmacologic Agents

ABSTRACTObjectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital.Methods:Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period.Results:Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%–2.3%), and desaturation (Sao2≤ 90) in 14 of 979 (1.4%; CI 0.1%–2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs.Conclusions:Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients at a Swiss tertiary hospital

10.21203/rs.3.rs-22231/v2 ◽

2020 ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Hospital Admissions ◽

Tertiary Care ◽

Median Number ◽

Tertiary Hospital ◽

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 Switzerland. All patients and visits from January 2016 to December 2017were 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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