Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 6 Articles
Background: Some crucial decisions in treatment of hypothermic patients are closely linked to core body\ntemperature. They concern modification of resuscitation algorithms and choosing the target hospital. Under- as\nwell as over-estimation of a patientâ??s temperature may limit his chances for survival. Only thermometers designed\nfor core temperature measurement can serve as a guide in such decision making. The aim of the study was to\nassess whether ambulance teams are equipped properly to measure core temperature.\nMethods: A survey study was conducted in collaboration with the Health Ministry in April 2018. Questionnaires\nregarding the model, number, and year of production of thermometers were sent to each pre-hospital unit of the\nNational Emergency Medical System in Poland.\nResults: A total of 1523 ground ambulances are equipped with 1582 thermometers. 53.57% are infrared-based ear\nthermometers, 23.02% are infrared-based surface thermometers, and 20.13% are conventional medical\nthermometers. Only 3.28% of devices are able to measure core body temperature. Most of analyzed thermometers\n(91.4%) are not allowed to operate in ambient temperature below 10 Degree C.\nConclusions: There are only 3.28% of ground ambulances that are able to follow precisely international guidelines\nregarding a patientâ??s core body temperature. A light, reliable thermometer designed to measure core temperature\nin pre-hospital conditions is needed....
Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency\ndepartment (ED). Thus, its acute management is often done by physicians working in the ED. These clinicians are\noften general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of\npain management by these physicians may be important in relieving acute pain. We aimed to assess the\nknowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon.\nMethods: We carried out a prospective cross-sectional study over 4 months in the year 2018. We enrolled all\nconsenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of\nfive tertiary hospitals of Cameroon. Using a validated and pretested structured questionnaire, data on the\nknowledge, attitudes, and practices of acute pain management at the ED by these clinicians were studied. We used\nan externally validated score to assess the knowledge as either poor, insufficient, moderate or good.\nResults: A total of 58 physicians were included; 18 interns or residents and 39 general practitioners�����...
Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical\nservices. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients\nwith sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse\nprognosis. Therefore, early identification of patients with sepsis is important, and more information about the\nprehospital characteristics that can be used to identify these patients is needed. Based on this lack of information,\nthe objectives of this study were to investigate the prehospital characteristics that are identified while patients with\nsepsis are being transported to the hospital by the emergency medical services, and to compare these values to\nthose of the patients with and without adverse outcomes during their hospital stays.\nMethods: This was a retrospective observational study. The patientsâ?? electronic health records were reviewed and\nselected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an\nemergency department by the emergency medical services. Data were collected on demographics, prehospital\ncharacteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit,\nand analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital\ncharacteristics for predicting or development of adverse outcome were analysed.\nResults: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing\npatients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum\nglucose level and altered mental status during prehospital care were found to be associated with an adverse\noutcome.\nConclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature,\nincreased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient\nprognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with\nsepsis early and improve their long-term outcomes. However further research is required to predict limit values of\nsaturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients\nwith sepsis....
Background: Crowding in emergency departments (EDs) is a challenge globally. To counteract crowding in day-today\noperations, better tools to improve monitoring of the patient flow in the ED is needed. The objective of this\nstudy was the development of a continuously updated monitoring system to forecast emergency department (ED)\narrivals on a short time-horizon incorporating data from prehospital services.\nMethods: Time of notification and ED arrival was obtained for all 191,939 arrivals at the ED of a Norwegian university\nhospital from 2010 to 2018. An arrival notification was an automatically captured time stamp which indicated the first\ntime the ED was notified of an arriving patient, typically by a call from an ambulance to the emergency service\ncommunication center. A Poisson time-series regression model for forecasting the number of arrivals on a 1-, 2- and 3-\nh horizon with continuous weekly and yearly cyclic effects was implemented. We incorporated time of arrival\nnotification by modelling time to arrival as a time varying hazard function. We validated the model on the last full year\nof data.\nResults: In our data, 20% of the arrivals had been notified more than 1 hour prior to arrival. By incorporating time of\nnotification into the forecasting model, we saw a substantial improvement in forecasting accuracy, especially on a one hour\nhorizon. In terms of mean absolute prediction error, we observed around a six percentage-point decrease\ncompared to a simplified prediction model. The increase in accuracy was particularly large for periods with large inflow.\nConclusions: The proposed model shows increased predictability in ED patient inflow when incorporating data on\npatient notifications. This approach to forecasting arrivals can be a valuable tool for logistic, decision making and ED\nresource management....
Background and Objectives: This study aims to identify reasons for unscheduled return\nvisits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from\na similar study conducted in the same institution 9 years ago. Materials and Methods: This\nretrospective study included adult patients who attended the emergency department (ED) of a\ntertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h\nfor the same or similar complaint. The primary outcome was wrong or delayed diagnoses.\nSecondary outcomes include admission to the ED observation unit or ward on return visit. Findings\nwere compared with the previous study performed in 2005 to identify trends. Results: Of 67,422\nattendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range\n24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%).\nOne hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors\n(adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain\n(2.99; 2.12-4.23), fever (1.60; 1.1-2.33), neurological deficit (4.26; 1.94-9.35), and discharge without\nfollow-up (1.61; 1.1-2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted\nodds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities\nof diabetes mellitus (2.07; 1.29-3.31), asthma (5.23; 1.59-17.26), and renal disease (7.48; 2.00-28.05);\npresenting complaints of abdominal pain (1.83; 1.32-2.55), fever (3.05; 2.10-4.44), and giddiness or\nvertigo (2.17; 1.26-3.73). There was a reduction in URV rate compared to the previous study in 2005\n(1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2%\nversus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever,\nand discharge without follow-up were associated with wrong or delayed diagnoses among URVs....
Introduction: Gold panning is the research and artisanal exploitation of gold\nin the auriferous areas (rivers or others). Traumatisms arising from these activities\nare due to severe spinal cord injury and generally affect young people\nin full activity. They constitute a real social handicap in Mali and even in\nAfrica. The aim of our study is to share our expertise in the management of\nthese vertebro-medullary traumas in these miners who currently escape to all\ncontrols in Mali. Material and Methods: From 2013 to 2016, 76 Traumatic\nSpine Cord Injuries (TSCI) were treated in the department of Neurosurgery\nof â??Hospital du Maliâ?. There were 73 males (96.05%) versus 03 Females\n(3.95%), aged between 21 - 43 years old. Results: All of our patients were\nadmitted with deficit differing from paraparesis to tetraplegia. According to\nFrankel scale, we found 59 patients with complete deficits (A grade, 77.63%),\nand incomplete deficits in 17 cases (12 grade B, 04 grade C, 01 grade D). The\nX-ray standard radiographies were done in 24 cases (31.58%) from which 02\npatients had been operated with these data. CT scan centered on the injured\nspinal segment was performed in 74 cases (97.37%). The lumbar spine was\naffected in 39 cases, followed by thoracolumbar junction in 19 cases and thoracic\nspine in 16 cases. The cervical spine was only interested in two cases.\nFractures dislocations are the most frequently lesions encountered in our series.\nThe surgical approach was performed in 74 patients and 02 patients received\nconservative treatment. Conclusion: Traumatic Spinal Cord Injuries\n(TSCI) among miners are a real disaster in Mali and continue to plague\nthousands of families or increase the number of disabled people in our society.\nIt is the only work, where the person concerned is making of his own\ngrave. And according to witnesses, several miners remained at the bottom of\nthe wells. Their prevention must first involve users by raising the awareness\nof local residents and traditional therapists, but also the country that must\nparticipate in regional development and ensure strict enforcement of regulatory\nmeasures. Our structure must have enough resources to acquire and\ntreat these patients at any time....
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