Proportion Of Emergency Department Presentations Research Articles

The clinical profile, management, and outcomes of deliberate self-poisoning in a tertiary care hospital, Pretoria, South Africa

Abstract Introduction: Deliberate self-poisoning is a major public health problem globally and constitutes a significant proportion of emergency department presentations. The purpose of the study was to determine the clinical profile, management, and outcomes of patients admitted with deliberate self-poisoning to a tertiary public academic center in South Africa. Methods: A review of the clinical records of medical admissions for deliberate self-poisoning over one year was conducted. Results: A total of 140 patient records were analysed. The mean age of the group was 25.7 ± 9.4 years of whom 75.6% were females. The majority (96.4%) of patients were unemployed. Pharmaceutical agents were the most common (75%) form of poisoning, taken orally by most (99%). Psycho-social stressors were responsible for deliberate self-poisoning in 49% of the patients. None of the patients had evidence of significant organ dysfunction at admission. Two patients were admitted to the intensive care unit. All patients survived. The median length of stay in the hospital was 5 days (IQR 4–7 days). Treatment consisted of supportive care and, where appropriate, gastric decontamination, administration of antidotes/reversal agents, and referral to psychosocial services. Conclusion: In this study, a high proportion of the patients were female, unemployed, and single. Psycho-social stressors were the predominant reasons for deliberate self-poisoning and pharmaceutical agents were the main form of poisoning in the majority of cases. Improving the mental health and coping skills of young females could potentially reduce episodes of deliberate self-poisoning among this vulnerable group.

Lessons from lockdown: Virtual Clinics and service reorganisation in fracture management during COVID 19 experience of an Irish Regional Trauma Unit

BackgroundTrauma places a burden on healthcare services accounting for a large proportion of Emergency Department presentations. COVID-19 spread rapidly affecting over 30 million worldwide. To manage trauma presentations the Department of Trauma & Orthopaedic Surgery reorganised service delivery. AimTo assess the impact of service reorganisation and Virtual Clinics on patients in a Regional Unit in Ireland. MethodsA retrospective review of trauma activity following introduction of Virtual Fracture Clinics and Theatre COVID Pathways for a 10 week period in comparison with the same 2019 period. All patients underwent both nasopharyngeal and oropharyngeal swabs PCR testing prior to operations. Theatre and outpatient activity were evaluated. Clinic data were accumulated using the Integrated Patient Management System. ResultsTheatre Activity: 242 patients underwent surgery in our trauma unit (mean 2.98 per list) during the COVID- 19 period. 29 cases were performed in repurposed elective hospital giving a total of 271 during the 2020 study period. 371 cases were performed in the same 2019 period (mean 4.58 per list). Outpatient Activity: We noted a 25.86% fracture clinic referral reduction during the COVID 19 period compared to 2019. There was a 150.77% increase in patients managed through Trauma Assessment Clinic. 639 patients were managed through the Virtual Fracture Clinic Pathway during COVID 19 period. ConclusionsOver one in four fracture clinic patients can be managed virtually. A new dedicated Acute Fracture Unit within our institution permitted streamlining of care and social distancing. The “Non-COVID” pathway for ambulatory trauma was essential in managing the growing presentations of these injuries.

Infections of the Hepatobiliary System

Hepatobiliary infections account for a small but clinically important proportion of emergency department presentations. They present a clinical challenge due to the broad range of imaging characteristics on presentation. Recognition of complications is imperative to drive appropriate patient care and resource utilization to avoid diagnostic pitfalls and avert adverse patient outcomes. A thorough understanding of anatomy infectious pathology of hepatobiliary system is essential in the emergency setting to confidently diagnose and guide medical intervention. Many presentations of hepatobiliary infection have characteristic imaging features on individual imaging modalities with others requiring the assimilation of findings of multiple imaging modalities along with incorporating the clinical context and multispecialist consultation. Familiarity with the strengths of individual imaging modalities in the radiologists' arsenal is imperative to guide the appropriate utilization of resources, particularly in the emergent time sensitive setting. Accurate identification and diagnosis of hepatobiliary infections is vital for appropriate patient care and management stratification.