Interspeciality Othering: A Qualitative Analysis of Physician Interpersonal Conflict at the Time of Admission From the Emergency Department

Although booster phone calls have been used to enhance the impact of brief interventions in the emergency department, there has been less number of studies describing the content of these boosters. We conducted a qualitative analysis of booster calls occurring two weeks after an initial Web-based intervention for drug use and intimate partner violence (IPV) among women presenting for emergency care, with the objective of identifying the following: progress toward goals set during the initial emergency department visit, barriers to positive change, and additional resources and services needed in order to inform improvements in future booster sessions. The initial thematic framework was developed by summarizing codes by major themes and subthemes; the study team collaboratively decided on a final thematic framework. Eighteen participants completed the booster call. Most of them described a therapeutic purpose for their drug use. Altering the social milieu was the primary means of drug use change; this seemed to increase isolation of women already in abusive relationships. Women described IPV as interwoven with drug use. Participants identified challenges in attending substance use treatment service and domestic violence agencies. Women with substance use disorders and in abusive relationships face specific barriers to reducing drug use and to seeking help after a brief intervention.

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Audit of the Wheat Pill Cases at Medicolegal Clinic Mayo Hospital Lahore

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32528 ◽

2021 ◽

pp. 86-90

Author(s):

Kanwal Zahra ◽

Maryam Shahid ◽

Waqas Aslam ◽

Usman Shahid Butt ◽

Nida Zahra

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Mortality Rate ◽

Age Groups ◽

Descriptive Study ◽

Monthly Basis ◽

History Of ◽

Medical University ◽

Time Of Admission

Objective: To determine the audit of wheat pill cases at medicolegal clinic of Mayo Hospital Lahore. Materials and Methods: This descriptive study was conducted at Department of Forensic Medicine and Toxicology (medicolegal clinic), King Edward Medical University Lahore. This audit was of 9 months from September 2020 to May 2021. Patients presented at emergency department with attempt of wheat pills poisoning of all age groups and both genders were included. Cases were diagnosis via history of wheat pills consumption by the relatives. All the cases were given primary recovery and were shifted to the Intensive Care Unit (ICU). Data was collected on monthly basis form September 2020 to May 2021. All the data was collected via study proforma. Results: Total 49 wheat pill cases were observed during 9 months, their mean age was 29.26±12.68 years. Out of all 51.0% were males and 49.0% were females. Labourer males and housewives were most common 34.7% and 40.8% respectively. Frequency of wheat pill cases were high in months of September, October and May. At the time of admission 59.2% cases were seen conscious, 36.7% were semiconscious and 4.1% were unconscious. Out of all 59.2% were died. Conclusion: This study observed that the wheat pills are highly toxic with the quick and high mortality rate. Strict legislations are recommended to the sale control of these pills all over the country.

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Analysis of genitourinary trauma patients admitted to the emergency department

IMC Journal of Medical Science ◽

10.3329/imcjms.v15i2.55807 ◽

2021 ◽

Vol 15 (2) ◽

pp. 32-37

Author(s):

İrfan Aydın ◽

Erdal Yavuz

Keyword(s):

Emergency Department ◽

Tertiary Hospital ◽

Trauma Patients ◽

Abdominal Organ ◽

Survivor Group ◽

Genitourinary Trauma ◽

Accompanying Injuries ◽

Hospital Patients ◽

Time Of Admission

Background and objective: Genitourinary injuries are commonly encountered in the emergency department but may be over looked in case of multi-trauma. Determining the clinical features of genitourinary injuries will help physicians in the management of genitourinary trauma. Methods: The study was conducted in a tertiary hospital. Patients of all ages, admitted in the emergency department, with trauma between 2015 and 2020 were included and analyzed. The cause of genitourinary trauma, affected organs, any accompanying injury, treatments, mortality status, and laboratory tests related to mortality were obtained from the hospital records and analyzed. Results: During the study period, 87 patients admitted to the emergency department with genitourinary trauma were included in the study. The majority of these patients (n=79) were male. Of the patients, 9.2% died. All the patients in the mortality group had additional injuries. The most frequently injured organ was determined as the kidney (51.7%), followed by the scrotum (25.3%) and penis (8.1%). Additional injuries were observed in 81.6% of the patients. Intra-abdominal organ injuries (19.5%) were the most common accompanying injuries. White blood cell count (WBC), aspartate aminotransferase (AST), alanine aminotransferase ( ALT), blood glucose and creatinine values measured at the time of admission to the emergency department were found to be higher in the non-survivor group. The majority of the patients (81%) were discharged with conservative treatment and follow-up. Conclusion: It was determined that genitourinary injuries were frequently seen with additional injuries. Genitourinary injury should be evaluated carefully, especially in the presence of intra-abdominal organ injuries. Ibrahim Med. Coll. J. 2021; 15(2): 32-37

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Incidence of COVID-19 in random trauma patients at DHQ Teaching Hospital, Rawalpindi, measures to prevent its spread among patients and health care workers

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24isupp-1.1437 ◽

2020 ◽

Vol 24 (Supp-1) ◽

pp. 67-70

Author(s):

Tariq Nawaz ◽

Bilal Mehmood ◽

Muhammad Waqas Ayub ◽

Irfan Malik ◽

Umar Qaisar

Keyword(s):

Emergency Department ◽

Preventive Measures ◽

Trauma Patients ◽

Penetrating Injuries ◽

Blunt Injuries ◽

Accident And Emergency ◽

Care Workers ◽

Total Female ◽

Male Patients ◽

Time Of Admission

Background: The objective of the study was to see the incidence of COVID-19 positive, in random trauma patients received in the emergency of abdomen or chest may be penetrating or blunt. Materials and Methods: This study was conducted in the Accident and Emergency department of District Head Quarter Hospital, Rawalpindi. All trauma patients of abdomen or chest either penetrating or blunt admitted from 1-3-20 to 10-6-20 were included, irrespective of age, gender, comorbidities, and COVID-19 status at the time of admission to hospital. Also to see steps of preventive measures taken in the emergency department, operation theatres, and inwards. Results: Total number of trauma patients received in the emergency department of District Headquarter Hospital Rawalpindi during this period was 163. Total male patients: 116. Total female patients:47. Penetrating injuries (firearm or stab wounds): 93. Blunt injuries: 70. All the penetrating injuries were operated as an emergency. Among blunt injuries, 51 were operated 19 were treated conservatively. Preoperatively none of the patients’ COVID-19 test was performed because none of them showed any symptoms likely of COVID-19 such as chest infection, flue, malaise, or fever. After the second postoperative day, 12 of the patients developed respiratory distress and their COVID-19 test was sent. Out of 12 patients, 7 turned out to be COVID-19 positive. Other on the second or third postoperative day 7 patients had fever without chest symptoms and underwent COVID-19 testing. 3 turned out to be COVID-19 positive. So a total of 11 patients were found to be positive for COVID-19. The percentage became 6.7% which is quite high. Conclusion: From this study, its clear in acute trauma patients where you can’t go for the COVID-19 test even then we have to operate may be positive. So every trauma patient should have suspected COVID-19 positive and preventive measures should be taken starting from the emergency department till operation theatres.

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Palliative medicine in the emergency department: symptom control and aggressive care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003332 ◽

2021 ◽

pp. bmjspcare-2021-003332

Author(s):

Raquel de Oliveira ◽

Carolina B. Lobato ◽

Leonardo Maia-Moço ◽

Mariana Santos ◽

Sara Neves ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Palliative Medicine ◽

Symptom Control ◽

Well Being ◽

Blood Collection ◽

Intravenous Fluid Therapy ◽

Aggressive Care ◽

Aggressive Interventions ◽

Time Of Admission

ObjectivesIdentifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.MethodsWe conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.Results384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.ConclusionsNearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.

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The influence of chief complaint on opioid use in the emergency department

Journal of Opioid Management ◽

10.5055/jom.2006.0035 ◽

2006 ◽

Vol 2 (4) ◽

pp. 228 ◽

Cited By ~ 1

Author(s):

Kathleen Puntillo, RN, DNSc, FAAN ◽

Martha Neighbor, MD ◽

Garrett K. Chan, APRN, BC, PhD ◽

Roxanne Garbez, RN, MS, ACNP

Keyword(s):

Emergency Department ◽

Rating Scale ◽

Patient Discharge ◽

Numeric Rating Scale ◽

Opioid Use ◽

Pain Scores ◽

Patient Pain ◽

Nurses And Physicians ◽

Time Of Admission ◽

Numeric Rating

The aim of this study was to explore factors influencing emergency department (ED) clinicians’ use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients’ mean (SD) pain intensity from the time of admission to the ED (7.3 ± 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 ± 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was “not in that much pain.” However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient’s decrease in pain.

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