Medicine & Dentistry

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Browsing Medicine & Dentistry by Subject "Emergency"

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    Management of Burns in Gaza-Strip A Multi-center Clinical Audit
    (Al-Quds University, Deanship of Scientific Research, 2020-12-22) Aldaya, Haneen Younis; Abu Jamie, Najlaa; Abu Shammala, Haneen; AL-Bashiti, Suzan; shaheen, Hala; Alazar, Ameera; Hammad, Motaz; Ghunim, Mohammed; Al Moghrabi, Ahmed; Bottcher, Bettina
    A combined prospective and retrospective study was conducted in the ERs of Al-Shifa, Nasser Medical Complex and European Gaza hospitals. Two structured questionnaires were used to collect the management of burn according to the Palestinian management protocol. This study found that from the 147 cases that came to the ER, 37.6% underwent ABCDE approach and 87.8% (n=129/147) received sterile dressings. Background: Burns is a global public health problem and appropriate intervention will decrease morbidity and mortality. This study aimed to evaluate the management of burns in the emergency room (ER), burns units and intensive care units (ICU) of the Gaza-Strip. Objectives: To evaluate the management of burns in the ER, burns unit and ICU in terms of following ABCDE approach, using sterile dressings, giving fluid resuscitation, antibiotics, ranitidine and undergoing physiotherapy. Methods: A prospective study evaluated the management of patients presenting with burns injuries to the ER between the period 22nd July to 20 August 2018, and retrospectively, management of patients was evaluated, who were admitted to the burns units and to ICU between 1st January 2017 and 30th July 2018 at Al-Shifa Hospital and Nasser Medical Complex. The Palestinian management protocol was used for evaluation. A total of 428 patients were identified to have burns injuries during the study period. Of these, 142 were excluded, 108 due to missing files and 34 files had poor documentation (no documentation of medication or assessments). Included were 147 patients admitted to ER, 122 on the burns unit and 17 on the ICU. Results: In the ER, 57.1% (n=84/147) of patients were male, with a mean age of 15.4±14.1. Of the 147 cases, 17.7% (n=26/147) were major burns, which included more than 10% total body surface area burned (TBSA). Of these, 37.6% underwent ABCDE approach and 87.8% (n=129/147) received sterile dressings. From the 122 patients admitted to the burns unit, 59.8% (n=73) were male with a mean age of 11.4±14.6 years. From these, 47.5% (n=58/122) underwent fluid resuscitation, 97.5% (n=119/122) received antibiotics, 17.2% (n=21/122) received ranitidine and 56.6% (n=69/122) underwent physiotherapy. Out of the 17 patients admitted to ICU, 76.5% (n=13/17) were male, with a mean age of 19.2±12.8 years. All of these patients received prophylactic antibiotics, 58.8% (n=10/17) had endotracheal intubation, 5.9% (n=1/17) underwent central venous pressure measurement (CVP), 23.5% (n=4/17) had ABG tested and 88.2% (n=15/17) kidney function tests (KFT), and 64.7% (n=11/17) received ranitidine. No patient had a chest X-Ray (CXR) or carbon monoxide (CO) level done. From the ICU patients, 17.6% (n=3/17) benefitted from physiotherapy, and 35.3% (n=6/17) Conclusion: The findings of this study demonstrate poor adherence to guidelines in some points, such as patients presenting with major burns, who should all benefit from the ABCDE approach, but less than 40% of patients actually did and antibiotics, which should only be prescribed when indicated, were given to nearly all patients admitted to the burns unit or ICU. Efforts are required to improve staff practices with burn injuries.
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    Quality of Pain Relief Provided in the Emergency Room (ER) for Patients with Acute Abdominal Pain A Prospective Clinical Audit
    (Al-Quds University, Deanship of Scientific Research, 2020-12-22) Abu Shammala, Haneen; El-Bari, Duha Abed; Abu Nasser, Eman; Othman, Huda; Abo Alkomboz, Tasneem; Kawrea, Rola; Ishtiawi, Nada; Al Naqeeb, Esraa; Jamie, Najlaa; Bottcher, Bettina
    A prospective study was conducted in the ERs of Al-Shifa, Indonesian and European Gaza hospitals, a structured questionnaire was used to collect characteristics of pain and its management. Pain intensity was recorded at different intervals using a 10-point numerical rating scale. This study found that patients attended to ER with a mean pain score of 8.3±1.4 and they left with a mean pain score of 4.6±3.5. burns. Background: Acute abdominal pain is the most common cause of surgical consultations in the ER and the most common cause of non-trauma related admissions. Little is known about pain management in Gaza Strip hospitals. Therefore, this study assesses whether patients presenting with acute abdominal pain received adequate analgesia, compared to the Royal College of Emergency Medicine Guidelines. Objectives: To assess pain management in the ER in terms of the prescription practice of pain-relieving medications, pain progression from arrival till disposition and adequacy of analgesics provided. Methodology: A prospective-observational study was conducted in the ERs of three Gaza Strip hospitals, representing three distinct geographical areas, from 30th July till 30th August. All Patients above 18 years old, presented to the ER with acute abdominal pain, with no history of analgesia intake before their hospital visit were included. Data was collected by nine trained interviewers through a structured questionnaire. Pain was quantified by the patients by a 10-point numerical rating scale. This was done on arrival as well as at 30 and 60 minutes after receipt of analgesia and at discharge. Verbal consent was obtained from the patients. Approval had been obtained from the Directorate General of Human Resources Development before data collection. Data were analyzed via SPSS and are presented as mean scores ± standard deviations as well as in total numbers and percentages. Results: A total of 157 patients were included, 77 (49%) were males and the mean age was 39.8+15.4 years. Furthermore, 78 (49.7%) were from Hospital A, 52 (33.1%) from Hospital B and 27 (17.2%) from Hospital C. The sample included 100 (63.7%) patients with a provisional diagnosis of renal colic, 17 (10.8%) with biliary colic, 13 (8.3%) with appendicitis, 9 (5.7%) with intestinal obstruction and 18 (11.4%) other diagnoses. A total of 29 patients (18.5%) did not receive any analgesia in the ER. Of the 128 patients (81.5%), who received analgesics, 115 (89.8%) had non-steroidals while 13 (10.1%) received opioids. Opioids were adequately titrated in all patients and no circulatory instability occurred. The mean pain score on arrival was 8.3±1.4, while it was 7.1±3.6 30 minutes later, 6.6±4.2 after 60 minutes and 4.6±3.5 on discharge. Conclusion: Although pain relief was given and experienced pain decreased for most patients, but only seven patients (4.4%) were completely pain-free on discharge. Generally, patients with intense pain were quickly given analgesics. Hence, efforts should be focused on patients suffering moderate or mild pain to also receive adequate pain relief in the ER. Agreed local guidelines and training of staff could also facilitate this process.