Pancreaticobiliary Malignancies in the Emergency Room: Management of Acute Complications and Oncological Emergencies

Background Management of pancreaticobiliary (PB) malignancies remains a clinical challenge. In this review, we focus on the management of oncological emergencies in PB malignancies and the potential complication of associated therapeutic interventions. Methods Biobliographic review of current evidence on the management of oncological emergencies, their potential complications, as well as synthesis of recommendations was performed. The pathogenesis, frequency, related symptoms as well as appropriate investigations are presented. Results The oncologic emergencies in PB patients were summarised in six categories: (1) hematological (including febrile neutropaenia, thrombocytopenia, coagulopathies), (2) gastrointestinal (gastric outlet and biliary obstruction, gastrointestinal bleeding), (3) thromboembolic events, (4) ascites, (5) metabolic disorders and (6) neurologic complications. The pathogenesis, frequency, related symptoms as well as appropriate investigations are also presented. Conclusion Patients with PB malignancies are at increased risk of a wide variation of medical emergencies. Clinical knowledge, early recognition and collaboration with the relevant specialties are critical to manage these complications effectively, tailoring overall management around the actual prognosis and individuals’ expectations.

Analisis Overcrowded di Instalasi Gawat Darurat Rumah Sakit Umum Daerah Raden Mattaher Provinsi Jambi

This study aims to see the density of patient visits at the Raden Mattaher Regional Hospital by using the National Emergency Department Overcrowded Scale (Nedocs). The method used in this study is an analytical survey to assess the role and function of an emergency room management and to analyze the management of patients in the emergency room at the Raden Mattaher Regional General Hospital (RSUD), Jambi Province. The results of this study indicate the average overcrowded rating in the ER at Raden Mattaher Hospital Jambi, which is in the range of 61-100 with the assessment category Very busy but not too full (extremely busy but not overcrowded). According to the Ministry of Health, the calculation of the need for human resources for nurses, the number of nurses in the ER at Raden Mattaher Hospital is short of 4 people, and not all of them are emergency certified. Based on the research results, it can be concluded that the policy decision making has been implemented but it has not been implemented properly. Furthermore, regarding the density in the emergency room during patient visits, the Raden Mattaher Regional Hospital provides a step solution to hospital management.