Overbevolking op spoedgevallen in relatie tot ziekenhuis-verworven verwikkelingen

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Prehospitaalgebruik van perifere katheters en impact op de interventietijd: een retrospectieve monocentrische studie

Tijdens prehospitaalinterventies wordt er quasi reflexmatig een perifere katheter geplaatst, vaak zonder duidelijke medische noodzaak. In deze retrospectieve monocentrische studie werd de frequentie van het plaatsen van deze katheters nagegaan. Verder werd er een correlatie gezocht tussen de plaatsing van een katheter, de ernst van de pathologie en de impact op de interventietijden. Gedurende een periode van één jaar werd de indicatie voor het plaatsen van een perifere katheter nagegaan op basis van gegevens uit de MUG-fiche. Er werd een onderscheid gemaakt tussen een katheterslot, een vochtinfuus en intraveneuze medicatietoediening. Voor elke interventie werd er een „modified early warning score” (MEWS) berekend. Van de 922 geregistreerde interventies werden er 395 weerhouden. Zonder katheter bedroeg de interventietijd gemiddeld 10,11 minuten, met een katheterslot 13,75 minuten, met een vochtinfuus 16,77 minuten en met intraveneuze medicatietoediening met of zonder intraveneus vocht 17,45 minuten. Er was een significant verschil in de gemiddelde MEWS in de groep patiënten bij wie geen katheter (1,25 ± 0,15) geplaatst werd in vergelijking met patiënten bij wie dit wel (2,45 ± 0,16) gebeurde (p < 0,01). Het plaatsen van een perifere katheter ging gepaard met een significante toename van de interventietijden. Deze studie suggereert een vooralsnog onvoldoende medisch gericht gebruik van perifere katheters.status: publishe

Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis

OBJECTIVE: To evaluate an automatic forecasting algorithm in order to predict the number of monthly emergency department (ED) visits one year ahead. METHODS: We collected retrospective data of the number of monthly visiting patients for a 6-year period (2005-2011) from 4 Belgian Hospitals. We used an automated exponential smoothing approach to predict monthly visits during the year 2011 based on the first 5 years of the dataset. Several in- and post-sample forecasting accuracy measures were calculated. RESULTS: The automatic forecasting algorithm was able to predict monthly visits with a mean absolute percentage error ranging from 2.64% to 4.8%, indicating an accurate prediction. The mean absolute scaled error ranged from 0.53 to 0.68 indicating that, on average, the forecast was better compared with in-sample one-step forecast from the naïve method. CONCLUSION: The applied automated exponential smoothing approach provided useful predictions of the number of monthly visits a year in advance.publisher: Elsevier articletitle: Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis journaltitle: International Emergency Nursing articlelink: http://dx.doi.org/10.1016/j.ienj.2013.08.001 content_type: article copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.status: publishe

Management of the pregnant trauma patient: A literature study

Background: Trauma frequently occurs during pregnancy and can affect both mother and unborn child. It is essential to consider pregnancy in every female trauma patient of reproductive age. The management of a pregnant trauma patient is often considered to be complicated.Main body: Therefore, it is important to follow a clear management protocol of the appropriate approach of the pregnant trauma patient. Furthermore, some pregnancy-specific complications of trauma such as placental abruption, uterine rupture, premature uterine contractions and their management are presented.In pregnancy, the ABCDEF approach is used during the primary survey with the ‘F’ standing for fetus. Fetal vital signs are an important indicator of the maternal condition, and fetal outcome depends on maternal wellbeing. Concerning the secondary survey, a physical examination as well as indicated technical examinations should be performed with fetal monitoring being essential in a viable pregnancy. In case of non-reassuring findings, emergency caesarean section or laparotomy may be indicated.In case of cardiac arrest, advanced trauma life support management should be started and the aetiology of cardiac arrest should be sought using the BEAUCHOPS tool. Early airway protection with adequate oxygenation and ventilation as well as effective chest compressions with tilting of the mother or manual displacement of the uterus, are essential.&nbsp;Conclusion: A systematic approach (ABCDEF) of the traumatised pregnant patient is even more essential than in the non-pregnant patient. Saving the mother is crucial if you also want to save the unborn child.</p

Ethylene glycol poisoning presenting with a falsely elevated lactate level

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Emergency Department Crowding in Relation to In-Hospital Adverse Medical Events: A Large Prospective Observational Cohort Study

BACKGROUND: Emergency department (ED) crowding has been linked with adverse medical events. However, this association was inadequately controlled for potential confounding variables. OBJECTIVES: To investigate whether ED crowding is independently associated with risk of in-hospital death and morbidity, and longer total hospital stay. METHODS: Prospective observational cohort study of all patients (≥ 18 years) presenting to the ED of an academic teaching hospital in Leuven, Belgium from June 21, 2010 to July 20, 2012. Multivariate logistic regression and proportional hazard analysis was used to control for risk factors. ED occupancy was determined for 108,229 included patients and labeled "ED crowding" when occupancy was within the highest quartile of occupancy. Outcomes within 10 days of ED admission included in-hospital death, hospital-acquired morbidities, and total hospital stay. RESULTS: During ED crowding, a median of 58 (interquartile range 55-63) patients were present for 40 licensed treatment bays. After controlling for all baseline risk factors and as compared with the lowest quartile of ED occupancy (30 [26-32] patients), ED crowding was not independently associated with mortality (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.74-1.19; p = 0.6), but tended to be associated with higher incidence of hospital-acquired pneumonia (OR 1.24, 95% CI 0.96-1.62; p = 0.09). CONCLUSIONS: Failing to control for baseline risk factors may have led to false-positive associations between ED crowding and mortality in previous studies. After controlling for risk factors, we showed that ED crowding was associated with longer hospital stays but not with increased mortality.publisher: Elsevier articletitle: Emergency Department Crowding in Relation to In-hospital Adverse Medical Events: A Large Prospective Observational Cohort Study journaltitle: The Journal of Emergency Medicine articlelink: http://dx.doi.org/10.1016/j.jemermed.2015.05.034 content_type: article copyright: Copyright © 2015 Elsevier Inc. All rights reserved.status: publishe

Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital

STUDY OBJECTIVE: The epidemiology, management and cost of emergency department (ED) visits for deliberate self-poisoning (DSP) are described. METHODS: In a retrospective study, the medical records of all DSP patients older than 16 years, who presented to the ED from 1 January 2009 to 31 December 2009, were reviewed. RESULTS: 312 episodes of DSP were included, accounting for 0.6% of all ED visits. 190 patients were women, with a female to male ratio of 1.56:1. Mean patient age was 37 years. More than 60% (n=190) of DSP patients were <40 years of age. Most patients presented to the ED between 18:00 and 23:00. A single drug was ingested in 39% (n=121) of patients. Alcohol was co-ingested by 36% of patients who were mostly middle-aged men. Of the overdoses, 50.8% were due to benzodiazepines, 23.2% were due to antidepressants and 16.4% were due to antipsychotics. Two-thirds of patients were treated with oral activated charcoal and 89% were seen by a psychiatrist. Nearly 90% of patients were admitted to the ED observation ward, with a mean length of stay of 16.7 h. The estimated total cost was €;266 134.89, with an average of €;872.57 per patient. CONCLUSION: Self-poisoning cases in Belgium are grossly similar to those in other Western countries. Supportive treatment alone should be considered in the majority of patients presenting with oral drug overdose. Overall, DSP leads to a significant financial burden on the community.status: publishe

Intravenous lipid emulsion for intentional Chloroquine poisoning

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Emergency department visits due to alcohol intoxications: characteristics of patients and impact on the emergency room

AIMS: The aim of the study was to describe the epidemiology, management and cost of emergency department (ED) visits due to alcohol intoxication. METHODS: A retrospective review of medical records of all episodes of alcohol intoxication was made, excepting those where another diagnosis such as trauma or psychiatric illness was primary, in patients older than 16 years, who presented to the ED of a large university hospital in Belgium over a 12-month period from 1 January 2009. RESULTS: A total of 635 such patients accounted for 1.2% of all ED visits; 429 were males and 48.3% were aged between 41 and 60 years; 63.8% of the patients had a history of alcohol use disorder and 60.3% had a history of psychiatric disorder; 74.3% of the patients received some form of medical treatment and 62% were seen by a psychiatrist. Of the total, 57.5% of the patients were admitted to the ED observation ward, with a mean length of stay of 8.4 h. The estimated total cost was €318 838.25, with an average of €541.32 per patient. CONCLUSION: Alcohol intoxication leads to a financial burden on the community. In addition to imposing physical, social and psychological stress on the community, the often agitated or aggressive patient imposes stress on ED staff. Close surveillance of trends in alcohol abuse is warranted, and the ED should consider implementing a questionnaire method of screening for alcohol abuse.status: publishe