EP.WE.202Atypical presentation of Acute Aortic Dissection Standford type A dissection

Introduction Acute aortic dissection type A (AADA), a tear in the intima lining of the aorta, is a surgical emergency and contributes to high mortality rate if not managed promptly with surgical intervention. Case presentation We describe a case of a 63-year-old female with a history of hypertension presented with presumed seizure and hypotension to the emergency department. She did not have Computed Tomography (CT) chest despite having hemopericardium on her CT abdomen and pelvis. Her condition deteriorated to pericardial effusion, cardiac tamponade, multi-organ failure and shock. A diagnosis of AADA was only found on the stage of post-mortem. Conclusion AADA may not present with classical symptoms of tearing chest pain. The combination of hypotension and neurological deficit should trigger hospital team to consider aortic dissection higher up in the differential diagnosis for shock. If there is unclear diagnosis for an acutely unwell patient, hospital team should review the case and radiological imaging again. Hemopericardium on CT abdomen, pelvis should trigger hospital team to request for a CT chest to look out for the cause of hemopericardium. AADA is fatal without prompt surgical intervention. Immediate diagnosis can significantly reduce the mortality rate.

The Regulation on Emergencies in Workplaces: Applicability in a University Hospital

Introduction: Hospitals provide healthcare services to society during and after emergencies. Therefore, the hospitals should be well-prepared for emergencies and have easy applicable, and efficient emergency plans. We aimed to investigate the applicability of emergency regulations in a university hospital. Methods: It is a descriptive study in which the current emergency plan of a university hospital is compared with the regulations and legislation in effect in Turkey. The number of teams and officials included in the teams in the current legislative emergency plan are identified and compared to the available emergency teams in a hospital for the present study. Results: The present study identified the potential emergencies in accordance with the “Regulation on Emergencies in Workplaces” and the conditions in the particular region and hospital. 16 teams were identified for these emergencies and the number of officials in each team was confirmed. In the current staff of the hospital, there were 12 teams. Additionally, three teams were identified in the current hospital team that was not stated in the regulation. Although stipulated in the regulations, chemical, biological, radiological, and nuclear teams, and national medical rescue teams were not available in the hospital. Therefore, these teams and the number of officials in each team were determined. Discussion: Due to the geopolitical location of Turkey, the high disaster risk in the region, and the history of disasters, all hospitals should have applicable and constantly updated emergency plans. The number of teams in emergency plans and the number of officials in these teams should be arranged under current legislation, size of the hospitals, risk analyses, and functionality. With this study, we determined the emergency teams and the number of staff in the hospital.

Rural and Remote Intubations in An Australian Aeromedical Retrieval Service: A Retrospective Cohort Study.

Objective Critically unwell patients in rural and remote areas of Queensland, Australia, often require airway management with rapid sequence intubation (RSI) prior to retrieval to a tertiary centre. Retrieval Services Queensland (RSQ) coordinate retrievals and support rural hospitals, including via telehealth. We aimed to describe the demographics of patients intubated in Queensland hospitals requiring subsequent aeromedical retrieval. This retrospective cohort study compared patients intubated by a retrieval team, including a LifeFlight Retrieval Medicine (LRM) doctor, to those intubated by the local hospital team. MethodsRetrospective cohort study of all patients intubated in hospitals in Queensland, Australia, requiring subsequent aeromedical retrieval (including an LRM doctor) between January 2019 and December 2019. Data collected included: time of day, mission priority, geographical location of hospital, rurality, diagnosis, failure/assistance with intubation. Descriptive statistics were complemented by logistic regression analyses. Results In 2019, 684 patients were intubated in hospitals in Queensland, Australia, requiring subsequent aeromedical retrieval by a team including an LRM doctor. 131 (19.2%) were intubated by the retrieval team, and 553 (80.8%) were intubated by the local hospital team. The retrieval team was more likely to intubate as the age of the patient increased. In the most rural and remote areas, 64 (43.2%) of patients were intubated by the retrieval team, compared with 84 (56.8%) by the local team. In this subgroup of rural and remote patients, the composite diagnosis of ‘injuries, poisons, toxicology and drugs’ was significantly more likely to be associated with the local team intubating. ConclusionA retrieval team is more likely to be required for intubation of patients in rural and remote hospitals in Queensland, Australia. Service provision for critically unwell patients, coordinated by RSQ, is effective and well-managed. Rural and remote hospitals should be given special preference and consideration for timely dispatch of the retrieval team for assistance with these cases.Trial RegistrationEthical approval for this project was granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (LNR/2020/QRBW/64917). A waiver of consent was granted given the retrospective and deidentified nature of the study.

Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary–secondary care interface

BackgroundObstructive sleep apnoea (OSA) presents a major healthcare challenge with current UK data suggesting that only 22% of individuals have been diagnosed and treated. Promoting awareness and improving access to diagnostics are fundamental in addressing these missing cases and the recognised complications associated with untreated OSA. Diagnosis usually occurs in secondary care with data from our trust revealing long wait times to undertake tests, reach a diagnosis and start treatment. This places a considerable time and emotional burden on the patient and a financial and logistical burden on the hospital.MethodsWe introduced an integrated community-based pathway for the diagnosis of OSA. This comprised a monthly clinic run from within a local general practice (GP) supported by a ‘virtual multidisciplinary team’ run by the hospital specialist team. Prospective collection of process, outcome and patient satisfaction data was compared with traditional hospital-based pathway data collected retrospectively.SettingA central London teaching hospital and GPs within a local commissioning neighbourhood.ResultsBetween January 2018 and February 2019, 70 were patients referred and managed along the community pathway. Compared with the hospital pathway, data demonstrated a significant reduction in the time taken: from referral to perform a sleep test (29 vs 181 days, p<0.0001), to make a diagnosis (40 vs 230 days, p<0.0001) and commence treatment (127 vs 267, p<0.0001). Patient satisfaction in the community pathway was higher across all domains (p<0.05), fewer hospital outpatient appointments were required and cost estimates suggested an overall saving of up to £290 could be achieved for each patient.ConclusionAn integrated community-based pathway results in more timely diagnosis of OSA within a local setting while maintaining specialist input from the hospital team. It is favoured by patients and can reduce unnecessary appointments in secondary care.

Liaison old age psychiatry

Liaison psychiatry is a sub-specialty of psychiatry that specializes in the interface between physical and mental health, and involves treating patients who are attending general hospitals. This chapter provides an overview of the development of old age liaison psychiatry with consideration of the commissioning and funding of services. It discusses the importance of liaison psychiatry services being integrated within the general hospital team. It outlines different models of liaison psychiatry and provides examples of different services in the UK. It describes common conditions seen within older adult liaison psychiatry and considers screening tools and outcomes. Finally, it covers other aspects of the role of liaison psychiatry, such as teaching, training, governance and accreditation of services and considers interfaces with other services and the future of liaison psychiatry.

CHALLENGES OF THE MEDICAL TEAM DURING HOSPITAL TREATMENT OF PATIENTS WITH SUSPECTED COVID-19

In December 2019, a new disease was identified in China. From the investigation of cases of pneumonia of undefined origin, researchers came to the identification of a new coronavirus, named SARS-CoV-2. The health sector in Brazil is facing a huge load from the disease pandemic. Since February 26, 2020, when the first case of COVID-19 was registered in São Paulo, the Unified Health System, which offers universal access to health services, and the private sector face a growing pressure and overload on the system, with 241 thousand cases, 16 thousand deaths and 8 million of tests performed. In the most affected regions, health systems are near to the collapse - the result of years of fragmentation and decades of financial cuts, and deprivations of human and technical resources. This scenario never before faced in most of western countries, but already seen in eastern countries, is a major challenge for health teams and health managers in Brazil. This review aims to elucidate the main challenges of the hospital team in the management of patients suspected of COVID-19 during the 2020 pandemic in Brazil.

Percepção de pacientes oncológicos infanto-juvenis, profissionais de saúde e familiares sobre o adoecimento - revisão sistemática

The understanding of the real meaning of the universe of feelings experienced by pediatric-juvenile cancer patients representes a challenge for the multidisciplinary health team. This study aimed to provide a better understanding of how children and adolescents with cancer understand the disease, the care by health professionals, the experience of living at hospital team and their relationship with family members involved in this process. It was a systematic review that included qualitative and quantitative studies published between 2014 and 2018, in English and Portuguese, which were selected from the PUBMED, Scielo, BDENF databases. A total of 599 articles were found and 5 were selected because they met the established inclusion criteria. It was observed that all studies were carried out in human beings, covering 281 children, adolescents, their parents and health professionals, addressing their perceptions and experiences during the treatment of cancer. It was found that the diagnosis of cancer has a different impact on each patient and, as a rule, is related to negative feelings, such as fear, anxiety and depression. The biggest challenge cited by patients was their reintegration into daily activities. It was reported by parents and health professionals that children have a high degree of suffering, which is shared by family, caregivers and health professionals. The realization of this study enabled a better understanding of the daily lives of these children and adolescents, the way they relate to health professionals and their families.