Emergency Medicine

Primary internal hernias are extremely rare in adults. They are an important cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is nonspecific. Imaging has been of limited utility in cases of acute intestinal obstruction; moreover, interpretation of imaging features is operator dependant. Thus, internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected. We report herein a case of a 45-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the sigmoid colon in the left paracolic gutter. The segment of intestine was reduced and the hernial defect was closed. Our finding represents an extremely rare v...

Des analyses préliminaires des pollutions organiques totales et fécales des eaux de deux cours d'eau et trois étangs piscicoles de l'Est de la RD Congo ont été réalisées en utilisant les méthodes chimiques (O 2 , DBO 5 , DCO) et biologiques (bactériologie, étude des macro-invertébrés et algues). Les résultats obtenus montrent que certaines eaux sont non-polluées et d'autres sont peu polluées par les matières organiques totales. Tandis que toutes ces eaux sont polluées par des parasites fécaux à divers degrés. Abstract Study of total organic pollution and fecal in aquatic ecosystem of Eatern democratic of Congo Preliminary analysis of organic and fecal pollution of water in two river and three pond of Eastern of DRCongo was realized using chemical methods (DO, BOD 5 , COD) and biological (bacteriology, macro-invertebrate and algal).The results obtained shown that some water was no polluted and others more polluted by total organic matter. But, all the water was polluted b...

Objectives To describe morbidity and multimorbidity patterns among adults readmitted to an Australian regional health service, in terms of occurrence of the same and different morbidities at index admission and readmission. Methods This cohort study used hospital admissions data for patients admitted between 1 July 2014 and 30 June 2016 to estimate proportions of unplanned readmissions (‘early’ within 30 days and ‘late’ within 1–6 months) with the same and different morbidities as the index admission. Readmission rates were estimated by selected sociodemographic, admission and diagnostic characteristics. Results The majority of early and late readmissions were in different diagnostic groups and for different primary morbidities to the index admission. Only 38.8% of readmissions were in the same major diagnostic group as the index admission and 18.4% in the same Adjacent Diagnosis-Related Group. Twenty one percent of admitted patients were readmitted within six months, with this incr...

P192 Background: One strategy that has been advocated to increase the percentage of stroke patients treated with thrombolytic therapy is the establishment of primary stroke centers in community hospitals. Methods: A stroke center was established at a 397-bed private community hospital in Bethesda, Maryland consistent with published recommendations (M. Alberts, et al, JAMA. 2000;283:3102). Following a 4 month pilot phase during which the stroke critical care pathway was introduced into hospital practice, around the clock coverage by the on-call stroke team was initiated on January 3, 2000. According to the pathway, the team was to be paged for any patient identified with a suspected new stroke and persistent deficits of less than 6 hours in duration (initial screening criteria). Observations of patient characteristics and times of key points in acute management are reported through July, 2000. Results: Sixty-four patients met the initial screening criteria (58 of these patients arriv...

Introduction We have implemented a VFC model during the COVID-19 pandemic to minimise the number of face-to-face consultations and the risk of transmission. Method The VFC was implemented and assessed using 3 PDSA cycles. Initially, a paper referral system was introduced along with treatment pathways. Subsequently an electronic referral system was established. The 3rd PDSA cycle involved training A&E staff on referrals and treatment pathways. At each stage the number of VFC referrals and clinic follow-ups were measured. Patient satisfaction was assessed using a telephone survey with a random sample of 30 patients. Results There was a statistically significant reduction in face-to-face follow-ups between pre-VFC (Total:4083, Average:86.87) and post-VFC (Total:713, Average:35.65) p-value<0.0001. There was a statistically significant increase in patient satisfaction after the implementation of the electronic referral system and staff re-training(9.25) compared to paper referrals(8.2...

Purpose: This study analyzes changes in the epidemiology of fractures during the SARS-CoV-2 era. Its aim was to better understand the workload of the orthopedic department, as well as the management of healthcare professionals, in this situation, with a view to ensuring optimal resource allocation in the event of any future epidemic emergency. Methods: Admissions to the orthopedic emergency room for trauma care were analyzed with reference to the period January 2019 to April 2020. The rate of hospitalized patients (group A) and the rate of patients discharged pending delayed surgery (group B) were recorded. Furthermore, distribution of the various fracture types, and of different trauma dynamics, was also evaluated. Results: The data show a reduction in the number of total admissions (from an average of 70.92/day to 21.15/day during the COVID period). In the pre-COVID era, patients requiring hospitalization accounted for 7.01% of all admissions; this rate increased to 12.47% in Marc...

Background: Substance abuse is rapidly growing with changing patterns of substance use. There is a substantial amount of data as regards the correlation between drug abuse and injuries managed in the emergency department (ED). Objective: The aim of the current work was to estimate the incidence of substance abuse related medical disorders among patients presented to Mansoura Emergency Hospital and the outcome of management of those cases Patients and methods: This prospective observational clinical study included a total of 250 patients arrived at ED, Emergency Hospital-Mansoura University with positive history of drug abuse and verified by Urine drug screening. Results: The incidence of substance use disorders (SUDs) among the studied cases was 11.2%. There were statistically significant correlations between toxicological screening results and studied cases presentation to emergency department. Male gender, single status, younger age and low income were the most frequently involved factors. Drug abusers were significantly increased among smokers. Conclusion: Of all adult patients presented to ED at Emergency Hospital-Mansoura University, about 10% of them had SUD. They were mostly male, single, younger age with unsatisfactory income. The outcomes focus on the significance of the potential roles of the ED as a site for interventions aimed at reducing harm from SUDs.

Enclosed-space smoke inhalation is the fifth most common cause of all unintentional injury deaths in the United States. Increasingly, cyanide has been recognized as a significant toxicant in many cases of smoke inhalation. However, it cannot be emergently verified. Failure to recognize the possibility of cyanide toxicity may result in inadequate treatment. Findings suggestive cyanide toxicity include: (1) a history of an enclosed-space fire scene in which smoke inhalation was likely; (2) the presence of oropharyngeal soot or carbonaceous expectorations; (3) any alteration of the level of consciousness, and particularly, otherwise inexplicable hypotension (systolic blood pressure ≤90 mmHg in adults). Prehospital studies have demonstrated the feasibility and safety of empiric treatment with hydroxocobalamin for patients with suspected smoke inhalation cyanide toxicity. Although United States Food and Drug Administration (FDA)-approved since 2006, the lack of efficacy data has stymied ...

Primary angioplasty in Argentina. Results from ARGEN-IAM-ST registry. Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95...

SummaryThis commentary discusses how much we appear to know about self-harm and the circumstances in which it may occur but how little we really know about what works in managing it. It reviews how suggestions for its management conflict with what we know about self-harm and the outcomes of young people. The challenge appears to be how better to identify those at risk of further self-harm and to train frontline staff in this, so that at-risk individuals may be referred to specialist services. Perhaps there is also a need to review the evidence for what actually works in reducing repetition of self-harm.

Background The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results A total of 26/42 indicators could be c...

To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-res...

Desde os primeiros casos de resistência a penicilina e depois meticilina,o Staphylococcus aureusse tornou degrande importância no ambiente hospitalar e atualmente também na comunidade. Glicopeptídeos são a primeiralinha de tratamento para infecções graves por MRSA, porém a alta toxicidade dos mesmos e, resistência,fazem com que as outras alternativas terapêuticas sejam adotadas na prática clínica para o tratamento de infecçõescausadas por S. aureus. Esta revisão pretende abordar as principais opções de tratamento antiestafilocócicos.

Background Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia. Methods A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis. Results Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior sur...