Anaesthetic considerations for emergency laparotomy

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jacek Wadełek
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
High Risk ◽  
Adverse Outcomes ◽  
Emergency Laparotomy ◽  
Life Threatening ◽  
The Right ◽  
Level Of Experience ◽  
Time Frames ◽  
Reduced Time

The majority of patients undergoing emergency laparotomy have potentially life?threatening conditions that require prompt intervention. The reduced time?frames available due to surgical urgency necessitate prompt and senior decision?making to minimise delays. The time taken to correct any anomalies needs to be balanced against the need for prompt surgery, particularly in time?sensitive situations involving sepsis or hypovolaemia. Therefore, corrective measures may be performed in parallel with surgery. Patients undergoing emergency laparotomy are at a high risk of adverse outcomes. Key elements of care for these patients include repeated risk assessment, early antibiotic therapy, as well as fluid resuscitation and appropriate timely interventions provided by clinicians with the right level of experience.

scholarly journals Proactive risk assessment via fuzzy approach in a decisional process of consignment stock program adoption

2021 ◽  
Vol 343 ◽  
pp. 07012
Author(s):  
Monica Faur ◽  
Constantin Bungău
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Supply Chains ◽  
Fuzzy Inference ◽  
Assessment Instrument ◽  
Fuzzy Approach ◽  
Inference System ◽  
Program Adoption ◽  
The Matrix ◽  
The Right

The idea of adopting the consignment stock concept has enriched the landscape of efficient supply chains and their organizations, due to its major benefits in reducing inventory, compressing delivery time and increasing flexibility towards achieving agility and enhanced market responsiveness. The decision making process is a complex one, as besides the benefits and the economical and administrative aspects, there are also risks that must be identified, measured, assessed and managed. There is little research in the literature concerning the risks and constraints of consignment inventory implementation, while consignment contracts are widely applied in both physical and virtual supply chains. This paper introduces a model of proactive risk assessment via a fuzzy approach, allowing a sensitivity analysis of the identified risks in the matrix, in terms of probability to happen, degree of severity, impact and potential consequences, as well as mitigation. A fuzzy inference system is used to serve as assessment instrument, to fairly and more rigorously evaluate the risks, in order to avoid critical situations during or after program adoption, or even implementation failure. Fuzzy logic theory has been chosen to capture the uncertainty that usually occurs when dealing with risks and decision making. We believe that having these risk assessment insights at hand, managers and practitioners can achieve a better understanding of the challenges that come along with a new consignment program adoption, while allowing them to make the right and justified decision, in accordance with both benefit and risk considerations.

O20 Quick, simple and just as effective—comparing pm: L3 ratio to NELA, P-POSSUM and NSQIP scores in assessing mortality risk for emergency laparotomy

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
P Pockney ◽  
J Gani
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
High Risk Patients ◽  
Acs Nsqip ◽  
Psoas Muscles ◽  
Risk Patients

Abstract Introduction Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle: L3 vertebrae (PM: L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Result PM: L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042–1.122; range 0.141–3.934). PM: L3 ratio is significantly lower (P < 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746–0.984]) and 90 days (mean 0.888 [95%CI 0.768–1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033–1.179], 90 day mean 1.112 [95% CI 1.070–1.154]). These associations are similar to those calculated by established risk assessment models. Conclusion PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. Take-home Message PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. It is comparable to NELA, P-POSSUM and ACS-NSQIP.

Deprescribing in older people

2020 ◽  
Vol 81 (1) ◽  
pp. 1-9 ◽  
Author(s):  
M Sinead O'Mahony ◽  
Anita Parbhoo
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Older People ◽  
Adverse Drug Events ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Pharmacological Management ◽  
International Evidence ◽  
Evidence Based Guidelines

Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. Deprescribing is an approach to managing polypharmacy and reducing adverse outcomes. Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.

THE RESEARCH OF RISK- AND CONDITION-BASED MAINTENANCE DECISION-MAKING AND TASK OPTIMIZING SYSTEM FOR ROTATING EQUIPMENT IN LARGE PETROCHEMICAL PLANTS

2012 ◽  
Vol 19 (04) ◽  
pp. 1250017
Author(s):  
QINGBIN YUAN ◽  
QINGFENG WANG ◽  
JINJI GAO
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Condition Monitoring ◽  
Service Oriented Architecture ◽  
Condition Based Maintenance ◽  
Decision Making System ◽  
Maintenance Decision ◽  
Rotating Equipment ◽  
The Right ◽  
And Task

Downtime of rotating equipment in large petrochemical plants often led to serious or even disastrous safety and environmental accidents, which generally stem from inadequate maintenance or incapability of failure prediction. In order to allocate maintenance resources rationally and improve the reliability, availability and safety of equipment, a kind of risk- and condition-based maintenance decision-making and task optimizing system for rotating equipment in large petrochemical plants is established in this paper. Using real-time database, web service and service-oriented architecture (SOA), a risk- and condition-based maintenance decision-making system architecture is developed to provide a unified data structure and man–machine interface, which integrates reliability-centered maintenance (RCM), condition monitoring system (CMS) and manufacturing executive system (MES) together. Risk assessment and condition monitoring technology is applied to form maintenance decision making, such as to determine the priority maintenance level, to optimize maintenance content, and to determine the right maintenance time. Based on the decision-making system, the risk rank and degradation trend of failure characteristics are used to support the decision making and to optimize maintenance tasks. The result of an engineering case shows that the maintenance decision-making based on the risk assessment and condition monitoring can lower the operational risk while enhancing the reliability, availability and safety.

scholarly journals ALGORITHM OF DECISION-MAKING ON SOCIAL AND MEDICAL PROTECTION IN EMERGENCY SITUATION

2019 ◽  
Vol 98 (1) ◽  
pp. 11-16
Author(s):  
Vladimir Yu. Soloviev ◽  
V. F. Demin ◽  
V. I. Krasnyuk
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
High Risk ◽  
Risk Group ◽  
Emergency Situation ◽  
Well Being ◽  
High Risk Group ◽  
Specific Situation ◽  
Protective Measures ◽  
The Social

The aim of the study. The development of decision-making algorithm for decisions on the social and medical protection of people in emergency situations based on risk analysis. Material and methods. The problems and conceptual provisions of risk assessment and decision-making, based on its results, are described concerning the social and medical protection of personnel of hazardous industries and the population in the event of an emergency situation (ES) in which the level of exposure to hazardous factors may exceed the established safety standards. The object of risk assessment and analysis are stochastic (probabilistic) effects of exposure to ES hazard factors. Their main features, which create complex problems in risk assessment and making decisions on protective measures, is the non-specific effects of the hazardous factors’ impact on human health and their possible latency. Results. The first step before decisions on the protective measures should be to identify a high-risk group among people affected by ES, based on the risk assessment. Three variants of decision-making for the high-risk group are considered: 1) financial compensation for risk, 2) medical measures for protecting health and 3) compensation for the realized damage to health. The requirements of the risk assessment methodology are formulated. Discussion. It is shown that the first option can not provide optimal and justified protection of the health and well-being of people in ES. Decisions on this protection are proposed to be based on a combination of options 2) and 3). The choice of the optimal combination depends on the specific situation and development of emergencies, on the success of implementing engineering and organizational protective measures aimed at preventing "doses" of exposure to people of hazardous factors of the emergency above the established safety limits and on the effectiveness and timeliness of medical protection. Conclusion. The choice of the option of making an effective decision on social and medical protection should be based on the detailed risk assessment from the exposure to hazardous factors, including risk assessment in economic indicators.

Surgery, Chemotherapy, and Radiotherapy for Gynaecological Cancer

2021 ◽  
pp. 356-364
Author(s):  
Konstantinos Pantazis ◽  
Ioannis Andronikidis ◽  
Lazaros Nikiforidis ◽  
Anne Floquet ◽  
Konstantinos Dinas
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Side Effects ◽  
High Risk ◽  
Complication Rates ◽  
Benefit Ratio ◽  
Oncology Treatment ◽  
Complications Of Surgery ◽  
All Treatment

Gynaecological oncology treatment yields no fewer complications and side effects than those met in any other oncology field. Patients and clinicians are highly alerted by the ominous diagnosis and sometimes seek for high risk, experimental, or even unproven therapies and are consequently prepared to accept high complication rates that would otherwise be unacceptable. Still, risk reduction remains a high priority. This is achieved by appropriate risk assessment, risk-to-benefit ratio balancing, treatment individualisation, close follow up through all treatment stages, and prompt patient informing and participation in decision making. The chapter aims to summarize the main complications of surgery, chemotherapy, and radiotherapy as well as the main ways to overcome them.

Channelopathy in athletes

2019 ◽  
pp. 253-264 ◽  
Author(s):  
Nicole M. Panhuyzen-Goedkoop ◽  
Arthur A.M. Wilde
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Ventricular Tachycardia ◽  
Cold Water ◽  
Polymorphic Ventricular Tachycardia ◽  
Volume Depletion ◽  
Long Qt ◽  
Life Threatening ◽  
Qt Syndrome

Channelopathies are primary inherited electrical disorders (prevalence 2–4%). Long QT syndrome (LQTS), short QT syndrome (SQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS) predispose to life-threatening ventricular arrhythmia (VT/VF). Several triggers can provoke VT/VF, such as exercise (LQTS,CPVT), vagotonia (BrS), hyperthermia (LQTS and BrS), immersion in cold water (LQTS), or electrolyte/volume depletion. It is a challenge for the screening physician to recognize the signature ECG changes of channelopathy at rest (LQTS, SQTS, BrS) or during exercise (CPVT) to identify the disease and assess the risk of VT/VF. Eligibility decision-making should involve cardiological expertise in channelopathy and determination of phenotypic and genotypic expression, and is not solely based on the assumption that channelopathies induce VT/VF. This chapter discusses the clinical presentation, management, and risk assessment in athletes of the four major channelopathies (LQTS, SQTS, CPVT, and BrS).

‘Walking on ice’: The future of parole in a risk-obsessed society

2019 ◽  
pp. 136248061988055
Author(s):  
Monica Barry
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Criminal Justice ◽  
High Risk ◽  
Risk Reduction ◽  
The Public ◽  
The Future ◽  
Key Drivers ◽  
The Uk ◽  
Risk Assessment And Management

The aim of risk assessment and management in criminal justice is increasingly about minimizing opportunities to create harm to the public rather than maximizing opportunities to create change in offenders. This seems to be particularly the case in respect of parole, where the balance of public protection with rehabilitation has become increasingly unstable in prioritizing the former. This article examines parole decision making and management within the UK from the perspectives of both high risk offenders on licence and parole professionals. It discusses two key drivers to burgeoning recall rates: the stringency of licence conditions and the propensity of professionals to recall in the name of risk elimination rather than risk reduction. The article concludes that the effectiveness of parole is in question, not least in enabling re-entry and reintegration of high risk prisoners. In particular, the future sustainability of parole itself is deemed to be under threat.

scholarly journals High Risk Features of an Anomalous Origin of the Right Coronary Artery

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Dre Eleonore Campiche ◽  
Jean-Paul Vallée ◽  
David Carballo
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Artery Bypass ◽  
Young Athletes ◽  
Rare Congenital Abnormality ◽  
Life Threatening ◽  
The Right ◽  
Anomalous Coronary ◽  
Left Sinus Of Valsalva

Anomalous aortic origin of the coronary arteries (AAOCA) is a rare congenital abnormality. It is usually asymptomatic and often found incidentally during coronary angiography. However, it can also be discovered during the autopsy of young healthy adults who have suffered from sudden cardiac death (SCD). AAOCA represents the second most common cause of SCD in young athletes. Herein, we report a case of a 39-year-old patient with left-sided right coronary anomaly with multiple high-risk features who presented with life-threatening symptoms for SCD but normal electrocardiography, echocardiography, and cardiac markers. The coronary computed tomography revealed an anomalous coronary artery from the left sinus of Valsalva with a hypoplasic origin and a high-risk path between the aorta and the pulmonary artery with a short intramural path. He was surgically managed with a coronary artery bypass with an uneventful follow-up.

Failure mode effects and criticality analysis: innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 173-181 ◽  
Author(s):  
Emilie S. Powell ◽  
Lanty M. O’Connor ◽  
Anna P. Nannicelli ◽  
Lisa T. Barker ◽  
Rahul K. Khare ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Emergency Department ◽  
High Risk ◽  
Failure Mode ◽  
Venous Catheter ◽  
Optimal Care ◽  
Mode Effects ◽  
Critical Areas ◽  
Criticality Analysis

AbstractSepsis is an increasing problem in the practice of emergency medicine as the prevalence is increasing and optimal care to reduce mortality requires significant resources and time. Evidence-based septic shock resuscitation strategies exist, and rely on appropriate recognition and diagnosis, but variation in adherence to the recommendations and therefore outcomes remains. Our objective was to perform a multi-institutional prospective risk-assessment, using failure mode effects and criticality analysis (FMECA), to identify high-risk failures in ED sepsis resuscitation.We conducted a FMECA, which prospectively identifies critical areas for improvement in systems and processes of care, across three diverse hospitals. A multidisciplinary group of participants described the process of emergency department (ED) sepsis resuscitation to then create a comprehensive map and table listing all process steps and identified process failures. High-risk failures in sepsis resuscitation from each of the institutions were compiled to identify common high-risk failures.Common high-risk failures included limited availability of equipment to place the central venous catheter and conduct invasive monitoring, and cognitive overload leading to errors in decision-making. Additionally, we identified great variability in care processes across institutions.Several common high-risk failures in sepsis care exist: a disparity in resources available across hospitals, a lack of adherence to the invasive components of care, and cognitive barriers that affect expert clinicians’ decision-making capabilities. Future work may concentrate on dissemination of non-invasive alternatives and overcoming cognitive barriers in diagnosis and knowledge translation.

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