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1.
Praxis (Bern 1994) ; 109(1): 35-41, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910762

RESUMO

CME: Hypercalcemia Abstract. Hypercalcemia is defined as albumin-corrected calcium >2.6 mmol/l. Symptoms of hypercalcemia are mainly neurological-psychiatrical and cardiovascular. Severe symptomatic hypercalcemia is an emergency and requires an immediate therapy. At the same time, the underlying cause of hypercalcemia has to be identified and treated. Based on pathophysiology, hypercalcemia can be divided into four groups: parathyroid hormone dysfunction, disturbances of vitamin D metabolism, of bone metabolism or of renal calcium excretion. Medical history and specific laboratory diagnostics help to identify one of these groups and to make the correct final diagnosis.


Assuntos
Hipercalcemia , Cálcio/metabolismo , Cálcio na Dieta , Emergências , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hormônio Paratireóideo
4.
Anaesthesia ; 75(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531978

RESUMO

Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P-POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow-up was 1.3 (0.1-1.8 [0.0-2.5]) years for the cohort, 1.5 (1.1-2.0 [0.0-2.6]) years after laparotomy and 0.0 (0.0-1.1 [0.0-2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow-up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6-21 [0-49]) and 4 (2-6 [0-36]) years, respectively, p < 0.0001. 'Poor fitness' precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients.


Assuntos
Laparotomia/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Estudos de Coortes , Emergências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Reino Unido
6.
Kyobu Geka ; 72(13): 1093-1096, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879387

RESUMO

The patient was a 52-year-old man who had undergone total arch replacement for type A aortic dissection 2 months before. He was admitted to our hospital with hemoptysis due to aortobronchial fistula. We planned to perform 1-stage open chest surgery, but he passed away before the surgery. We considered that earlier open surgery or emergency endovascular stent grafting might have been effective in avoiding this result.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Fístula Brônquica , Implante de Prótese Vascular/efeitos adversos , Fístula Brônquica/etiologia , Emergências , Hemoptise , Humanos , Masculino , Pessoa de Meia-Idade , Stents
7.
Lancet ; 394(10209): 1592, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31690431
8.
J Emerg Manag ; 17(5): 349-357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31736041

RESUMO

At a national and international level, governments have advanced all-hazards readiness and implemented disaster management systems within multiple industries, services, and sectors. This scope included public health agencies and healthcare providers, whose roles evolved in purpose and expectation within their respective communities, but their core mission remained unchanged. Real-world emergencies and disasters routinely challenge hospitals and affirm that healthcare providers must be prepared to provide, sustain, and expand critical services during times of crisis. This study reviews emergency management (EM) and disaster preparedness programing specifically within hospitals and healthcare systems to assess overall effectiveness. Analysis includes a review of existing program administration literature and regulatory and accreditation agency standards. Initial findings suggest ongoing efforts are needed nationwide to improve hospital EM capabilities and enhance the resiliency of American healthcare infrastructure. Identified gaps include limitations of pertinent research, inconsistent program evaluation metrics and processes, and hindering perceptions of profession role and purpose. Recommendations are provided to refine the traditional hospital EM profession and advance overall program administration competencies, as well as considerations for future research opportunities.


Assuntos
Planejamento em Desastres/organização & administração , Desastres , Emergências , Serviços Médicos de Emergência/organização & administração , Competência Profissional , Pessoal de Saúde , Hospitais , Humanos , Saúde Pública , Estados Unidos
9.
J Emerg Manag ; 17(5): 371-379, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31736043

RESUMO

Emergency management has traditionally been led by an attitude to react and respond and implement effective recovery efforts. The focus has now shifted to a preparedness perspective, promoting measures which encourage the public and responders to be better equipped leading to an increased level of resiliency. Effective use of Recreation-based stakeholders and facilities, in emergency planning, boasts a number of positive elements to all phases of emergency management. A literature review will focus on the importance of Recreation in relation to preparedness. Findings will seek to articulate how the involvement of Recreation, in the realm of preparedness, builds community resilience, enhances response and recovery operations and provides a unique leadership and knowledge base regarding the use of recreational infrastructure. This effort in turn leads to a community more capable of managing an incident and returning to normalcy.


Assuntos
Defesa Civil , Planejamento em Desastres , Emergências , Recreação , Canadá , Humanos
10.
Pan Afr Med J ; 33: 254, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692805

RESUMO

Introduction: Postoperative complications are common; some are transient, others may be serious, but they are all important to patients. One of the most important gaps in surgical research is the lack of consensus over the preferred result, the type of measurement or of evaluation. Methods: We conducted a retrospective study of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott. Eight hundred thirty-four patients underwent surgery over a seven-month period (1 January 2017-31 July 2017). The demographic and clinical parameters were studied and analyzed statistically using SPSS software 20. Results: The study involved 834 patients, of whom 426 (51.1%) were men. The average age of patients was 34.81 years (1-90 years). Four hundred thirty-two (51.2%) patients underwent emergency surgery. The sex ratio (M/F) was 1.04. Arab-Berbers race accounted for 77.8%. Appendicular disease accounted for 41.12%, hepatobiliary disease accounted for 17.76%, and abdominal wall disease accounted for 16.1%). Thyroid disease accounted for 5.6%. One hundred eighty-three (21.94%) patients developed postoperative complications, including 4 (2.1%) deaths. Clavien-Dindo grade II was the most represented with 82.5% of complications and accounted for 17.91% of all operated patients. Surgical site infection accounted for 62.8% of all complications. Conclusion: This study shows that the Clavien-Dindo classification can be applied to patients who have undergone elective surgery and emergency surgery. We think that the lack of follow-up and the lack of means to fight the infection and the non-rigorous respect of asepsis and antisepsis procedures would play an important role.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Adulto Jovem
11.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
14.
J Emerg Manag ; 17(4): 257-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603518

RESUMO

The Fukushima disaster following the March 11, 2011 earthquake and tsunami in Japan demonstrates the complexity of responding to nuclear emergencies during a natural disaster. Current international safety standards and guidance do not specifically address this type of situation. The potential conflicts between the response to the conventional impacts and the radiological consequences, real and perceived, can impede the effectiveness of the overall emergency response. The present article discusses the strategic and operational challenges likely to be encountered in such a complex emergency, and draws conclusions on how countries should better plan for the low probability but high consequence impacts of natural disasters coincident with a nuclear accident at a nuclear power plant.


Assuntos
Desastres Naturais , Liberação Nociva de Radioativos , Emergências , Acidente Nuclear de Fukushima , Humanos , Japão , Centrais Nucleares , Tsunamis
15.
J Emerg Manag ; 17(4): 287-303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603520

RESUMO

Effective emergency management and response require appropriate utilization of various resources as an incident evolves. This manuscript describes the information resources used in chemical emergency management and operations and how their utility evolves from the initial response phase to recovery to event close out. The authors address chemical hazard guidance in the context of four different phases of emergency response: preparedness, emergency response (both initial and ongoing), recovery, and mitigation. Immediately following a chemical incident, during the initial response, responders often use readily available, broad-spectrum guidance to make rapid decisions in the face of uncertainties regarding potential exposure to physical and health hazards. Physical hazards are described as the hazards caused by chemicals that can cause harm with or without direct contact. Examples of physical hazards include explosives, flammables, and gases under pressure. This first line of resources may not be chemical-specific in nature, but it can provide guidance related to isolation distances, protective actions, and the most important physical and health threats. During the ongoing response phase, an array of resources can provide detailed information on physical and health hazards related to specific chemicals of concern. Consequently, risk management and mitigation actions evolve as well. When the incident stabilizes to a recovery phase, the types of information resources that facilitate safe and effective incident management evolve. Health and physical concerns transition from acute toxicity and immediate hazards to both immediate and latent health effects. Finally, the information inputs utilized during the preparedness phase include response evaluations of past events, emergency preparedness planning, and chemical-specific guidance about chemicals present. This manuscript details a framework for identifying the effective use of information resources at each phase and provides case study examples from chemical hazard emergencies.


Assuntos
Vazamento de Resíduos Químicos , Defesa Civil , Planejamento em Desastres , Emergências , Humanos , Gestão de Riscos
16.
J Emerg Manag ; 17(4): 305-320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603521

RESUMO

The critical role of evacuation, particularly for the communities in developing countries exposed to cyclones, has only been realized after some disastrous evacuation experiences in recent cyclones. A profound understanding of the factors influencing the evacuation behavior is necessary to reduce the loss of lives, especially in the cyclone prone communities. The purpose of this research is to identify the key factors influencing households' evacuation decision during a cyclone in developing economies. To this end, the research employs state of the art discrete choice modeling techniques referred to as mixed logit models. The study builds on the data collected in 1991 from the coastal areas of Bangladesh following the cyclone Sidr. The analysis result reveals that the evacuees of developing countries like Bangladesh resort to nearby tall buildings during cyclone due to the insufficient facilities provided by the cyclone centers. In case of mandatory evacuation and for temporary house owner, the households' decision to evacuate is found to be uniform. However, significant heterogeneity is found in the households' decision to evacuate whenever they receive a voluntary notice and also if they live sufficiently far from the sea shore. The factors that are identified to be influencing households' evacuation decision during a cyclone will enable potential evacuees to better evaluate their decision and consequently make more informed decision about the timing as well as the necessity of evacuation. The analysis result will also help emergency managers to decide on the timing and the type of evacuation orders they need to provide for reducing causalities due to landfall caused by cyclones.


Assuntos
Tempestades Ciclônicas , Desastres , Bangladesh , Tomada de Decisões , Emergências , Humanos
20.
Afr Health Sci ; 19(2): 1910-1923, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656474

RESUMO

Background: There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. Objective: To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. Methods: This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). Result: The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). Conclusion: Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.


Assuntos
Emergências/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Anemia Falciforme/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Febre/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Malária/epidemiologia , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Sepse/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
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