Day :
- Emergency and acute care Medicine, Abdominal Emergencies, Psychiatric/Social Emergencies, Neurological Emergencies
Session Introduction
Anne-Frederique Naviaux
Universite Catholique de Louvain, Belgium
Title: Emergencies and Interventions in an out of hours Child and Adolescent Mental Health Service based in a General Hospital
Biography:
Anne-Frederique Naviaux is a consultant Psychiatrist and Child Psychiatrist, who finished her Master in Psychiatry in 2004 (Universite Catholique de Louvain, Belgium). She worked in France as a ‘praticien hospitalier’ in Child Psychiatry and for the World Health Organization, before joining the research department in Trinity College (Dublin, Ireland) in 2011. She has been a lecturer in France (IFSI) since 2004 but has also joined the Royal College of Surgeons of Ireland in 2012. She currently works for the Health Service Executive in Ireland as Head of Service in Summerhill Adult Mental Health Centre (Wexford) and as Clinical Lead for Liaison Psychiatry in Wexford General Hospital (WGH). Since 2016, she has been developing in collaboration with the Paediatric Team in WGH, an out of hours emergency service for young people with Mental Health Issues.
Abstract:
Having 25% of the total population aged under 18y old, Ireland struggles to provide appropriate Child and Adolescent Mental Health Services (CAMHS); this is directly connected to the lack of CAMHS consultants to lead these services. Accessing the existing CAMHS, especially in emergency, is particularly difficult as the waiting lists are ever growing, and therefore delaying the possibility of an early first appointment.
To palliate this, in Wexford and Waterford, we decided to be creative and to develop a new type of service: an out-of-hours Emergency Mental Health Service for young people, which provide assessments and interventions for under 18y old patients with Mental Health issues presenting in Emergency Department (ED) and/or hospitalised on a Ward. This new service functions with extremely limited resources (one consultant Psychiatrist and one Psychiatrist in training) and operates between 3 sites.
Results: A total of 675 interventions were delivered by the consultant responsible for that new Service over a period of 7 months (between February and August 2018). 59% of these interventions were made by phone while 41% required a face to face consultation.
Conclusion &Significance: Following this study, not only has this new service been maintained but it will developed and might also serve as a model for the other regions of Ireland which might want to develop a similar service.
Asanka Migelheva
University of Colombo , Sri Lanka
Title: Prevalence and factors associated with Burnout Syndrome among employees of Emergency Treatment units at selected Teaching Hospitals in Sri Lanka
Biography:
Asanka Migelheva has done the post-graduation from the University of Colombo , Sri Lanka.
Abstract:
Burnout Syndrome consists of depersonalisation, reduced personal accomplishment and emotional exhaustion.It was shown that among the health care workers those who work in the Emergency Treatment units (ETU) are more prone to be affected by the Burnout Syndrome during their employment period. This study was aim to determine the prevalence and factors associated with Burnout Syndrome among employees of three ETU in Sri Lanka.
A cross-sectional survey was conducted in three ETUs. The data were collected using a self-administered questionnaire developed incorporating Copenhagen Burnout Inventory (CBI), demographical data, general health related questions, and factors which may reduce burnout as perceived by workers. A convenience sample was collected from 167 participants composed of 78 medical officers (46.7%), 66 nurses (39.5%), 23 health care assistants (13.8%) .The mean personal burnout, work related burnout and client related burnout was respectively 37.1, 37.3 and 33.5. The prevalence of overall burnout 54 (32.3%) .There was no significant difference between the overall burnout level of workers in different ETUs .
The results of our study show that ETU healthcare workers are a vulnerable group for burnout and more than 30% of staff suffer from burnout and more than 75% of staff were in stress. Preventive approaches to burnout are needed to promote quality of work life.
Benjamin Schapira
University College London, London
Title: Necrotizing Enterocolitis in a patient post Roux-En-Y Gastric Bypass
Biography:
Ben Schapira graduated from UCL in 2020 with an MBBS and BSc in medical sciences. He is a young researcher working with a team of surgeons at the Whittington Hospital lead by Mr Hassan Mukhtar. Hasan Mukhtar completed his MBBS in 1989 at Punjab University, Pakistan followed by advanced surgical training at Oxford Deanery and West from where he was appointed as consultant colorectal and general surgeon at the Whittington Hospital in 2001. He is an Honorary Clinical Associate Professor of Surgery at UCL and has presented and published over 100 publications in national and international meetings and peer-reviewed journals.
Abstract:
Necrotizing enterocolitis (NEC) carries one of the highest mortality rates of all gastrointestinal disorders. Both its pathogenesis and aetiology remain enigmatic in adult patients. We report on the first known case of NEC following Roux-en-Y Gastric Bypass (RYGB) long-term.
A 42-year-old female patient (BMI 51.2) underwent RYGB. At 12 months follow-up she presented with diarrhoea, vomiting, tachypnoea and hypotension. She was severely acidotic (pH 6.9), white cell count (24x109/L) and lactate (7.3U/L). CT presented dilated bowel most prominently at the upper jejunum and she subsequently underwent laparotomy for small-bowel resection, subtotal colectomy and end ileostomy. Intraoperatively, patchy necrotic segments of colon were noted. Postoperatively, her lactate increased to 10U/L, necessitating relook laparotomy for further bowel resection. Caecal and ascending colon samples showed ischaemic and necrotic areas with transmural inflammation and marked bacterial overgrowth with no evidence of vascular compromise. These features resembled acute NEC. Clostridium, Campylobacter, Salmonella, Shigella and vasculitis screening were negative. She had a slow recovery, requiring total parenteral nutrition and at 36 months follow-up she is making good progress.
We believe an episode of binge eating led to gastrointestinal dilatation as seen in anorexia nervosa following rapid diet change. Such dilatation would diminish blood flow and damage mucosal integrity through ischaemia, permitting invasion of pathogenic gas-forming bacteria. With no specific diagnostic criteria; delayed diagnosis, time to surgery and failure to resect all necrotic tissue exemplify the challenges in management. We believe it’s important to highlight this case to raise awareness of similar presentations in post-bariatric surgery patients.
Bewket Tadesse Tiruneh
Monash University, Australia
Title: Incidence, and mortality associated with primary postpartum haemorrhage following in-hospital births in northwest Ethiopia
Biography:
Bewket Tiruneh is a PhD candidate at Monash University. He has published more than 28 papers in reputed journals.
Abstract:
Background: Primary postpartum haemorrhage remains the primary cause of maternal mortality in low-resource countries such as Ethiopia. National datasets about the incidence of primary postpartum haemorrhage are often limited, incomplete or unavailable.
Aim: To determine the incidence mortality, and factors associated with primary postpartum haemorrhage following in-hospital births.
Methods: This was a cross-sectional study design, an audit of 1060 maternity care logbooks of discharged women. The data were abstracted December to May 2018/2019 using systematic random sampling. The tool used was the Facility Based Maternal Death Abstraction Form. Data were entered, cleaned then analysed using SPSS version 25. Bivariate logistic regression was fitted. Adjusted odds ratio with 95% confidence interval was used to determine the statistical significance.
Findings: The incidence of primary postpartum haemorrhage was nearly 9.0% (95% CI: 6.91, 10.73). Of these, there was 7% maternal mortality. Predominant to women in Ethiopia health facility referrals of women in labour (AOR: 2.13; 95% CI: 1.19, 3.80), birth attended by final year medical students (AOR: 3.59; 95% CI: 1.89, 6.84), women who were discharged six hours following birth (AOR: 3.50; 95% CI: 1.24, 9.91) were associated with primary postpartum haemorrhage (p<0.05).
Discussion: This study found that the reported incidence of primary postpartum haemorrhage was relatively low, however, the associated deaths of women found was comparatively high.
Haran Devakumar
North Middlesex University Hospital, United Kingdom
Title: Improving the Diagnosis and Management of Lower Urinary Tract Infections in Older People
Biography:
Haran Devakumar is the medical doctor at the North Middlesex University Hospital, United Kingdom.
Abstract:
Aim - Achieving 90% of antibiotic prescriptions for Lower UTI in older people meeting UK NICE guidance for Lower UTI and PHE diagnosis of UTI guidance in terms of diagnosis and treatment
1) Diagnosis of Lower UTI based on documented clinical signs or symptoms
2) Diagnosis excluded use of urine dip stick
3) Urine sample sent to microbiology
4) Empirical antibiotic prescribed following NICE Guideline
Methods - All patients with a diagnosis of Lower UTI on discharge from ED were audited over 9 months (April – December 2019). Denominator: Total number of antibiotic prescriptions for all patients aged 65+, with a diagnosis of Lower UTI in North Middlesex ED. Numerator: Of the denominator, the number where the 4 audit criteria for diagnosis and treatment following PHE UTI diagnostic and NICE guidance are met and recorded. Exclusions: Recurrent UTI, pyelonephritis, catheter associated UTI, sepsis.
Background - In the 2016 national antibiotic point prevalence survey, 62.5% of antibiotic prescriptions for lower UTIs were deemed inappropriate. 50% of older adults and MOST with a urinary catheter will have asymptomatic bacteriuria. This is NOT harmful but will give a positive dipstick which can lead to inappropriate prescribing, promoting antibacterial resistance and healthcare associated infections i.e. Clostridium difficle.
Conclusion - We used Quality Improvement Methodology at the frontline to make significant and sustainable improvements in the diagnosis and management of Lower UTI in the over 65’s. Prescribed antibiotics are now compliant with NICE in 90% of cases compared with 44% in cycle 1. Nitrofurantoin and Fosfomycin now make-up 83% of prescriptions, compared to 18% in cycle 1. The use of urinary dipsticks has been dramatically reduced. The number of urine samples sent to the laboratory has increased which is essential to ensuring correct patient management and working towards the ambition to decrease gram negative bacteraemias by 50% by 2023.
Kulsoom Bano Mehdi
Aga Khan University Hospital, Pakistan
Title: Pneumocephalus, ICU management of an unusual condition, a tertiary care experience from Pakistan
Biography:
Dr. Kulsoom Bano Mehdi completed her MBBS in the year 2013 from Dow Medical College, Karachi, Pakistan. After graduation she did her Internship from Aga Khan University Hospital. Shortly after that she joined Department of Community Health Sciences, Aga Khan University as a research medical officer. Currently she is working as a resident, Internal Medicine department, Aga Khan University Hospital.
Abstract:
Pneumocephalus is caused by trauma and instrumentation which involves the sinuses, orbits, nasal passages or intracranial space. It can be managed conservatively but requires urgent neurosurgical intervention if tension pneumocephalus. There are many cases reported worldwide due to multiple causes but very few associated with ophthalmological procedures. We describe a rare case of pneumocephalus developing after dacrorhinostomy for bilateral nasolacrimal duct obstruction, managed in Medicine Intensive Care Unit conservatively.
A 62 year old lady presented with vomiting, drowsiness, respiratory distress and rhinorrhea. She had diabetes and ischemic heart disease and recent history of dacrocystorhinostomy for bilateral nasolacrimal duct obstruction. CT head showed cribriform plate rupture with tension pneumocephalus. She was treated with 100% inspired fraction of oxygen (FiO2) on mechanical ventilation, Fowler’s position, empiric antibiotics in meningitic doses, and complete sedation. Repeat CT Head after 3 days showed complete resolution of pneumocranium. She regained full consciousness and discharged home later.
Pneumocranium can also be caused by traumas after minor ophthalmological surgeries. If managed immediately by giving high flow oxygen, maintaining Fowler’s position, minimal position change and giving antibiotic and analgesics it can be resolved without the need for surgical intervention. To the best of our knowledge there is no case reported after trauma caused after dacrorhinostomy in Pakistan and abroad.