Review on Pneumothorax Diagnostic and Management Approach in Emergency Department

ObjectivesBreathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead.Design and methodsA qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen’s Transactional Model of Stress and Coping informed interpretive themes.ResultsInterviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.ConclusionsIn addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

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Working Together to Connect Care: a metropolitan tertiary emergency department and community care program

Australian Health Review ◽

10.1071/ah16236 ◽

2018 ◽

Vol 42 (2) ◽

pp. 189 ◽

Cited By ~ 3

Author(s):

Debra Harcourt ◽

Clancy McDonald ◽

Leonie Cartlidge-Gann ◽

John Burke

Keyword(s):

Mental Health ◽

Emergency Department ◽

Case Management ◽

Community Support ◽

Care Program ◽

Community Services ◽

Management Approach ◽

Frequent Users ◽

Frequent Attendance ◽

Working Together

Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a ‘frequent attendee’ was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of ‘super users’ is small compared with non-frequent users, the presentations are high. People in the frequent attendee group will often seek care from multiple EDs for, in the main, mental health issues and substance abuse. Furthermore, frequent ED users are vulnerable and experience higher mortality, hospital admissions and out-patient visits than non-frequent users. Aggressive and assertive outreach, intense coordination of services by integrated care teams, and the need for non-medical resources, such as supportive housing, have positive outcomes for this group of people. What does this paper add? This study uses international research findings in an Australian setting to provide a testing of the generalisability of an assertive and collaborative ED and community case management approach for supporting people who frequent a metropolitan ED. What are the implications for practitioners? The chronicling of a process undertaken to affect change in a health care setting supports practitioners when developing processes for this cohort across different ED contexts.

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Knowledge, attitudes, and practices regarding opioid use in the pediatric emergency department

Paediatrics & Child Health ◽

10.1093/pch/pxy054.026 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e10-e10

Author(s):

Megan Fowler ◽

Samina Ali ◽

Serge Gouin ◽

Amy Drendel ◽

Naveen Poonai ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Pediatric Emergency ◽

Management Approach ◽

Subspecialty Training ◽

Opioid Use ◽

Short Term ◽

Paediatric Emergency ◽

Opioid Crisis

Abstract BACKGROUND Inadequate pain management in children is ubiquitous in the emergency department (ED). Inadequate pain management in children can have both short and long term detrimental effects. As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. OBJECTIVES This study aimed to describe paediatric emergency physicians’ (PEPs) willingness to prescribe opioids to children in the ED and at discharge, perceived knowledge regarding common fears and myths about opioid use, management approach to hypothetical scenarios of varying musculoskeletal injury (MSK-I) pain in children, and perceived facilitators and barriers to prescribing opioids. DESIGN/METHODS A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillman’s Tailored Design method, from October to December 2017. RESULTS The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/- 8.7), and 58% (72/124) had paediatric emergency subspecialty training. The most common first line pain medication in the ED was ibuprofen for mild, moderate and severe MSK-I related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I pain, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0–100 scale, physicians minimally worried about physical dependence (13.3 +/-19.3), addiction (16.6 +/-19.8), and diversion of opioids (32.8+/-26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/-26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. CONCLUSION Intranasal fentanyl was the top opioid for all MSK-I pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols in the ED would likely improve physician comfort in responsible and adequate pain management for children.

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Ingested foreign bodies – a contemporary management approach

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131779 ◽

1995 ◽

Vol 109 (10) ◽

pp. 965-970 ◽

Cited By ~ 6

Author(s):

Michael Chi Fai Tong ◽

John Kong Sang Woo ◽

Cheuk Lun Sham ◽

Charles Andrew Van Hasselt

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Prospective Study ◽

Foreign Bodies ◽

Management Approach ◽

Modern Equipment ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

Contemporary Management ◽

A Prospective Study

AbstractA prospective study of all foreign body complaints presenting through our Accident and Emergency Department was conducted in a population where the condition is endemic. All patients were managed by otolaryngologists. Six hundred and eight patients were attended to yielding 179 foreign bodies. Making use of modern equipment and a practical approach, the requirement for examination under general anaesthesia was 6.3 per cent. In this series there was a complication rate of 0.5 per cent.

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Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

BMC Emergency Medicine ◽

10.1186/s12873-019-0296-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Viola Korczak ◽

Janani Shanthosh ◽

Stephen Jan ◽

Michael Dinh ◽

Thomas Lung

Keyword(s):

Emergency Department ◽

Cost Effectiveness ◽

Literature Review ◽

Case Management ◽

Narrative Review ◽

Future Research ◽

Management Approach ◽

Exclusion Criteria ◽

The Cost ◽

Effectiveness Studies

Abstract Background Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions. Method A systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies. Results One thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies. Conclusion The majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.

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Features and Results of Conducted Studies Using a Lean Management Approach in Emergency Department in Hospital: A Systematic Review

Bulletin of Emergency and Trauma ◽

10.29252/beat-070102 ◽

2019 ◽

Vol 7 (1) ◽

pp. 9-20 ◽

Cited By ~ 5

Author(s):

Haleh Mousavi Isfahani ◽

Sogand Tourani ◽

Hesam Seyedin

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Management Approach ◽

Lean Management

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Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review

Canadian Urological Association Journal ◽

10.5489/cuaj.2522 ◽

2015 ◽

Vol 9 (5-6) ◽

pp. 297 ◽

Cited By ~ 7

Author(s):

Michael Fuoco ◽

Leonard Cox ◽

Thomas Kinahan

Keyword(s):

Emergency Department ◽

Paranoid Schizophrenia ◽

Sensory Loss ◽

Management Approach ◽

Urinary Function ◽

Venous Circulation ◽

Dorsal Aspect ◽

Penile Amputation ◽

Microvascular Replantation

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-yearold patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter’s shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.

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Multiple Sclerosis flare-ups Diagnostic and Management Approach in Emergency Department, Review Article

World Journal of Environmental Biosciences ◽

10.51847/ntyl4xwgmv ◽

2021 ◽

Vol 10 (4) ◽

pp. 9-12

Author(s):

Nawaf Saad Alrusayyis ◽

‏Khaled Mohammed Alghamdi ◽

‏Bassam Mana Alahmari ◽

‏Ruba Mahmoud Barnawi ◽

‏Ali Yousef A Alfuraydan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Emergency Department ◽

Review Article ◽

Management Approach

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Urgent considerations for assessment of coma in the emergency department

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214043 ◽

2021 ◽

Author(s):

Tammam Mozher Aldarwish ◽

Talal Hussain Alolowi ◽

Rayan Othman Alsadiqi ◽

Hussain Ali Al Hassan ◽

Abdullah Saeed Alqahtani ◽

...

Keyword(s):

Emergency Department ◽

Physical Examination ◽

Treatment Plan ◽

Rapid Assessment ◽

Management Plan ◽

Management Approach ◽

Eyes Absent ◽

Assessment And Evaluation ◽

Evaluation Approaches ◽

Attending Physicians

Not speaking, closed eyes, absent response to tactile, verbal or noxious stimuli are characteristic of comatose patients. Many causes of coma have been identified and reported in the literature. However, other causes might require extensive assessment and evaluation approaches. The attending physicians start with the baseline support of life for the affected patients, followed by rapid assessment and evaluation of the etiology and pathophysiology and adequate physical examination. In addition, it requires imaging and laboratory investigations whenever needed to determine the most appropriate management plan. In this literature review, we have conducted a brief discussion about the urgent considerations for the assessment of coma in the emergency department. Many causes can attribute to the development of coma. Therefore, adequate assessment and evaluation is a key component in the management of the affected patients in the emergency department. Moreover, the management approach might differ based on the underlying etiology. Nevertheless, caring for breathing, circulation, management of the airways, and stabilization are the main steps that should be done for each comatose patient. Physical examination is also critical in such situations, where imaging or conducting laboratory tests might not be suitable for some patients. Finally, the treatment plan should be directed based on the underlying etiology of coma.

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