EMERGENCY SURGERY DURING COVID 19 AT K.A.P.V GOVERNMENT MEDICAL COLLEGE AND MGMGH , TRICHY

2021 ◽  
pp. 6-9
Author(s):  
Sumathi Ravikumar ◽  
Yeganathan Rajappan ◽  
Durairajan Vaithiyanathan ◽  
Catherine Sindhuja
Keyword(s):  
Surgical Intervention ◽  
District General Hospital ◽  
Favourable Outcome ◽  
Emergency General Surgery ◽  
Emergency Admissions ◽  
Medical College ◽  
Prolonged Duration ◽  
Current Impact ◽  
Emergency Surgical Intervention ◽  
The Impact

COVID 19 pandemic was declared by WHO as public health emergency on January 30,2020. Health system was reorganised with the aim to cope with the new disease and maintain essential health service. Many patients suffered from ARDS which lead to the modication of clinical and surgical activity. Current impact of COVID 19 outbreak on emergency surgical practice is still not developed. Varied presentation, diagnostic uncertainity, lack of guidelines present challenges to surgeons. AIM: The aim of our study was to evaluate the impact of the COVID-19 pandemic on emergency general surgery admissions and operations in our institution METHODS: We conducted a retrospective study in K.A.P.V.G.M.C. and M.G.M.G.H., Trichy from march 2020 to December 2020. All general surgical emergency admissions to KAPVGMC and MGMGH, district general hospital were included from march to December 2020.The details of diagnosis and subsequent management were retrieved from records. CONCLUSION: It was observed thatclinical decisions were made based on urgency of each case while simultaneously evaluating their COVID 19 status. The number of surgicalcases during COVID 19 period were signicantly reduced. Recognising asymptomatic carriers and need of emergency surgical intervention were the challenges faced by the surgeons. Effective communication between microbiologist, radiologist, anaesthetist and surgeon was necessary to attain a favourable outcome. .Inspite of challenges faced 80% had postoperative uneventful period other than prolonged duration of stay and were discharged and followed up. Covid 19 pneumonia and ARDS attributed to majority of death among the 20 % of deceased , other than septicemia

scholarly journals Ectopic pregnancy managed medically at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

2021 ◽  
Vol 14 (3) ◽  
pp. 85-88
Author(s):  
Jok Thikuiy Gang ◽  
Sisay Kirba Kea ◽  
Samson Gebremedhin
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Records ◽  
Selection Criteria ◽  
Surgical Intervention ◽  
Addis Ababa ◽  
Safe Alternative ◽  
Medical College ◽  
Endometrial Cavity ◽  
Emergency Surgical Intervention ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy, a pregnancy in which the embryo implants outside the endometrial cavity, is an important cause of maternal mortality, especially in developing countries. It can be managed medically using methotrexate. In Ethiopia, limited evidence exists regarding the treatment outcome of this approach.Methods: This retrospective study was conducted based on medical records of ectopic pregnancies managed medically using methotrexate. The data of women who had unruptured ectopic pregnancy and who were managed medically in the study period at St. Paul’s Hospital Millennium Medical College were included. Data were extracted from patients’ medical records and analysed using SPSS software.Results: During the 5-year period 2015 to 2019, 81 women with unruptured ectopic pregnancy were managed medically using methotrexate with 93.8% (n=76) success. Methotrexate was administered intramuscularly to all patients in either single dose or multiple doses. Five out of the 81 patients underwent surgical intervention for either ectopic rupture or persistent ectopic mass. There were no fatal complications.Conclusion: Methotrexate is a successful and safe alternative to surgical management of unruptured ectopic pregnancy in our settings. It should be given a trial in patients who meet the selection criteria in a setting ready for emergency surgical intervention and blood transfusions.

scholarly journals Reducing Prescribing Errors in Paediatric Patients by Assessment and Feedback Targeted at Prescribers

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Michael Eisenhut ◽  
Blanche Sun ◽  
Sarah Skinner
Keyword(s):  
General Hospital ◽  
Medical Errors ◽  
District General Hospital ◽  
Common Type ◽  
Prescribing Errors ◽  
Emergency Admissions ◽  
Wrong Dose ◽  
Written Assessment ◽  
Prescribing Medication ◽  
The Impact

Prescribing errors are the most common type of medical errors and can result in harm particularly in young children. Doctors were enrolled in a programme of written assessment in prescribing skills and individualized feedback. Pharmacists audited the impact. The setting was the paediatric wards and neonatal unit of a District General Hospital. 16 doctors were tested and received feedback. A total of 110 errors were identified in this test, out of a 51 were classified as major including wrong dose and frequency, and prescribing medication the patient had an allergy to. Audit of impact of this intervention revealed a reduction of errors from 47 to 21, and patients affected from 19 to 11 per 100 () emergency admissions compared to an audit before the intervention. An intervention combining a comprehensive multifaceted assessment and detailed feedback can lead to reduction of prescribing errors in paediatric trainees.

scholarly journals SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Oliver Brewster ◽  
Dale Thompson ◽  
Emma Sewart ◽  
Sarah Richards
Keyword(s):  
Abdominal Pain ◽  
General Surgery ◽  
District General Hospital ◽  
Surgical Patients ◽  
Emergency Admissions ◽  
Emergency Operations ◽  
Surgical Services ◽  
The Mean ◽  
The Impact ◽  
Second Wave

Abstract Aims Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital. Methods We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average. Results Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p < 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = <0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025). Conclusions We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.

Emergency surgery (DRAFT)

2018 ◽  
Author(s):  
Jonathan Wild ◽  
Emma Nofal ◽  
Imeshi Wijetunga ◽  
Antonia Durham Hall
Keyword(s):  
General Surgery ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Trauma Surgery ◽  
Emergency Operation ◽  
Emergency General Surgery ◽  
Symptom Palliation ◽  
The Impact ◽  
Theatre List

Emergency general surgery comprises patients with surgical problems requiring surgical intervention or post-operative surgical patients who require further surgical intervention or symptom palliation at any time of the day or night. Beyond the cases discussed below, this will include also emergency presentations from all of the sub-specialty chapters covered so far. Over 600,000 emergency hospital admissions are made to general surgery. Of these patients, they comprise the sickest patient cohort relative to the majority of elective patients, which results from sepsis, shock, or organ dysfunction from the underlying causative pathology, as well as the impact of any pre-existant comorbid states. This often has a significant impact on patient outcome, with high rates of morbidity and mortality relative to elective surgery. With this in mind, a lot of work has been channelled into improving outcomes for these patients. Furthermore, emergency and trauma surgery is beginning to establish itself as a subspecialty in itself. This chapter starts by making applied discussion of the assessment and initial investigation of acute abdominal pain, a complaint that comprises half of the annual 600,000 emergency general surgical admissions. It covers the pertinent features of diagnosis, investigation, and management of a range of common or serious emergency surgical and trauma cases that will be encountered on the acute surgical take. Kidney transplantation is not in itself an emergency operation when you consider the degree of pre-operative preparation of recipient donors, but is included in this chapter as it is commonly encountered by junior trainees on the emergency theatre list when donors are found at short notice.

scholarly journals Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

2016 ◽  
Vol 98 (2) ◽  
pp. 107-115 ◽  
Author(s):  
S Bokhari ◽  
U Walsh ◽  
K Qurashi ◽  
L Liasis ◽  
J Watfah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Best Practice ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Early Laparoscopic Cholecystectomy ◽  
Before And After ◽  
One Year ◽  
The Impact ◽  
Surgical Unit

Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

scholarly journals EP.WE.20At a glance: the impact of COVID-19 on Emergency General Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Aboul-Enein ◽  
Peter Ishak ◽  
Maninder Bhambra ◽  
Pol Ricart ◽  
Lisa Ishak ◽  
...  
Keyword(s):  
General Surgery ◽  
District General Hospital ◽  
Patient Questionnaire ◽  
X Rays ◽  
Long Term Effects ◽  
Emergency General Surgery ◽  
Patient Behaviour ◽  
The United Kingdom ◽  
Retrospective Data Collection ◽  
The Impact

Abstract Aim This study investigated the impact of COVID-19 on emergency general surgery practice, in a district general hospital in the United Kingdom, particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice. Methods Retrospective data collection from two cohorts: 112 patients admitted over one week in pre-COVID period and 90 patients admitted over one week during the COVID period. We used patient questionnaire and a consultant questionnaire to collect data on patient behaviour and consultant practice. Results Almost four times and seven times increase in performed X-rays (CXRs)and CT-thorax-abdomen-pelvis (TAPs) respectively. The COVID period saw 6.5% increase in conservative and 6.2% reduction in surgical management, and about 50% decline in length of stay (LoS) in conservatively managed patients. 71% of patients’ decisions to attend hospital were not affected and 78.6% of consultant surgeons preferred to manage patients conservatively during the COVID period. Conclusion Overall, there were delayed patients’ presentations to hospital at almost twice, increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients who were managed conservatively. Patient behaviour to attend hospital was not heavily influenced by COVID, but consultant practice certainly changed towards more conservative choices. Future studies should explore the impact on paediatric referrals and long-term effects on surgical training. This study's manuscript has been accepted for publication in the Surgical Practice Journal.

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

To Study the Clinical Profile and Management of Cellulitis of Lower Limb in Northern India

2021 ◽  
pp. 153473462098667
Author(s):  
Tripta S. Bhagat ◽  
Luv Kumar ◽  
Prakhar Garg ◽  
Apoorv Goel ◽  
Amit Aggarwal ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Lower Limb ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Cross Sectional Study ◽  
Common Complication ◽  
Cross Sectional ◽  
Medical College ◽  
Northern India ◽  
Working Age

Cellulitis is a bacterial infection of the dermis and subcutaneous tissues occupying a large proportion of hospital beds. This study was conducted for analysis of patients with cellulitis according to their demographics and clinical presentation and to examine their comorbidities, complications, and its management. This observational cross-sectional study was conducted in the Department of Surgery at Santosh Medical College and Hospitals involving a total of 60 cases having cellulitis and other soft tissue infections of lower limb. Analysis of their demographic profile, management, and complications was done. Cellulitis is seen commonly in males, 46 (76.6%). The mean age of patients affected by cellulitis in the study was 36.4 ± 1.23 years. The most common site affected is leg involving more people in field jobs. The most common risk factor was trauma in 46.6%, and other factors were diabetes mellitus and smoking, while abscess formation was the most common complication observed in 36.6% of cases. A total of 56.6% cases were managed conservatively, while 43.3% cases required surgical intervention. Mean hospital stay in this study was 5.02 ± 0.23 days. It was concluded that cellulitis is subcutaneous, spreading bacterial infection is more common in males, and its incidence is highest in working age group population. Lower limb is commonly involved. Trauma, smoking, and diabetes are significant risk factors for development of cellulitis. Abscess is the most common complication. About 50% patients with cellulitis can be managed conservatively and the rest require surgical intervention.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

scholarly journals Occupational burnout following the first wave of coronavirus disease at a Welsh district general hospital

2021 ◽  
pp. 175114372110100
Author(s):  
Gayathri Chinnappa Srinivas ◽  
Anwen Whitham ◽  
Rachel Rouse ◽  
Vincent Hamlyn ◽  
Matthew Williams
Keyword(s):  
Health Care Professionals ◽  
Response Rate ◽  
District General Hospital ◽  
Learning Opportunities ◽  
Direct Patient Care ◽  
Protective Equipment ◽  
Positive Outcomes ◽  
Occupational Burnout ◽  
Staff Burnout ◽  
The Impact

A survey was conducted to identify the prevalence of occupational burnout amongst health care professionals caring for COVID-19 patients in the Intensive Care Unit (ICU) of a Welsh hospital. The response rate was 79%. Nurses and other staff reassigned to work in the ICU had higher levels of burnout. Working in Personal Protective Equipment was most distressing, followed by direct patient care. There were positive outcomes including learning opportunities, professional development and job satisfaction. The impact of the pandemic on staff burnout may have been mitigated by acknowledging the contribution of staff, improving communication and encouraging them to access support.

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