scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

PAEDIATRIC POSTERIOR FOSSA TUMORS : AN EPIDEMIOLOGICAL AND ANALYTICAL STUDY AT TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 54-56
Author(s):  
S. I. Sadique ◽  
Md. Shahid Alam ◽  
S. Chatterjee ◽  
S. Ghosh
Keyword(s):  
Early Diagnosis ◽  
Posterior Fossa ◽  
Tertiary Care ◽  
Male Dominance ◽  
Morbidity And Mortality ◽  
Posterior Fossa Tumors ◽  
Tertiary Care Centre ◽  
Therapeutic Modalities ◽  
Common Location ◽  
Group 5

Introduction: Posterior fossa is the commonest site of primary intracranial tumors in children, accounting for 45-60% of 1 all pediatric tumors . The aims and objectives of the study is to analyse the incidence, clinical features, surgical outcome and complications in paediatric patients with posterior fossa tumor. Material and Methods: The present study is a non-randomized prospective observational study, conducted in the department of neurosurgery, Bangur Institute of Neurosciences (B.I.N), IPGME & R, Kolkata from January 2019 to December 2020. Sample size is 50. Observations & Results: Out of 480 cases of total CNS tumors who presented in the study period, 96 cases(20%) were of paediatric posterior fossa tumors. Male dominance was seen i.e. 32 cases(64%). Most of them were in the age group 5-12 years i.e. 30 cases(60%). Headache and vomiting was the most common presenting complain present in 41 cases(82%). Fourth Ventricle was the most common location, 30 cases(60%) with Medulloblastoma being the most common tumor, 24 cases(48%). Brainstem involvement was seen in 22 cases(44%). Post-op hydrocephalus and cerebellar mutism were seen in 6 cases(12%) each. Overall mortality was 8%(4 cases). Conclusion: Posterior fossa tumors are critical brain lesions with signicant neurological morbidity and mortality. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death. With rapid advancement in radiology and the advent of modern therapeutic modalities, early diagnosis and treatment reduced the morbidity and mortality rate and improved prognosis among the patients.

scholarly journals ROLE OF HEMATOLOGICAL PARAMETERS IN EARLY DIAGNOSIS OF COVID-19 IN A TERTIARY CARE CENTRE

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Angira Saha ◽  
Sakar Saxena ◽  
Romi Srivastava ◽  
Sanjeev Narang
Keyword(s):  
Early Diagnosis ◽  
Hematological Parameters ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Significant Difference

Aim: To evaluate the role of biomarkers from blood samples of COVID-19 patients admitted in Index Medical College Hospital & R.C. Material & Methods: Hematological parameters such as Neutrophil lymphocyte ratio (NLR), Platelet lymphocyte ratio (PLR) & Systemic Inflammatory Index (SII) were studied in RT-PCR positive patients to evaluate the utility of these parameters for early diagnosis of COVID-19. Results: The study showed that there was statistically significant difference in test groups in reference to Neutrophil lymphocyte ratio (NLR) & SII values (p<0.05). But no statistically significant difference was observed between test groups in reference to Platelet lymphocyte ratio (PLR) values (p>0.05). Conclusion: Leukocyte, Neutrophil, NLR & SII values can be used in the early diagnosis of COVID-19. Keywords: NLR, SII, Leukocyte, Neutrophil

scholarly journals P060: Cannabinoid hyperemesis syndrome presentation to the emergency department: a two-year multi-centre retrospective study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S98-S99 ◽  
Author(s):  
J.M. Hernandez ◽  
J. Paty ◽  
I. Price
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Case Series ◽  
Kappa Statistic ◽  
Cannabis Use ◽  
Data Abstraction ◽  
Tertiary Care Centre ◽  
Associated Symptoms ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Ed Visits

Introduction: Cannabinoid hyperemesis syndrome (CHS) is a paradoxical side effect of cannabis use. Patients with CHS often present multiple times to the Emergency Department (ED) with cyclical nausea, vomiting and abdominal pain, and are discharged with various misdiagnoses. CHS studies to date are limited to case series. We examined the epidemiology of CHS cases presenting to two major urban Tertiary Care Centre EDs. Methods: Using explicit variables, trained abstractors, and standardized abstraction forms, we abstracted data for all adults (18-55 years) with a presenting complaint of vomiting, and/or a discharge diagnosis of vomiting and/or cyclical vomiting, during a 2-year period. Inter-rater agreement was measured using a kappa statistic. Results: We identified 494 cases: mean age 31 years; 36% male; only 19.4% of charts specifically reported cannabis use. Among the regular cannabis users (>3 times per week), 43% had repeat ED visits for similar complaints. Interestingly, of these patients, 92% had bloodwork done in the ED, 92% received IV fluids, 89% received anti-emetics, 27% received opiates, 19% underwent imaging, 8% were admitted to hospital, and 8% were referred to the Gastroentorology service. Inter-rater reliability for data abstraction was kappa = 1. Conclusion: This study suggests CHS may be an overlooked diagnosis for nausea and vomiting, a factor which can possibly contribute to unnecessary investigations and treatment in the ED. Additionally, this indicates a lack of screening for CHS on ED history, especially in quantifying cannabis use and eliciting associated symptoms of CHS.

scholarly journals A prospective evaluation of the availability and utility of the Ambulance Call Record in the emergency department

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Natalie Cram ◽  
Shelley McLeod ◽  
Michael Lewell ◽  
Matthew Davis
Keyword(s):  
Emergency Department ◽  
Patient Management ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Relevant Information ◽  
Care Centre ◽  
Prospective Evaluation ◽  
Tertiary Care Centre ◽  
Handover Process ◽  
Collection Form

AbstractObjectiveTo determine how often the Ambulance Call Record (ACR) was available to emergency department (ED) physicians and whether it contained information that changed the ED management of patients.MethodsThis was a prospective cohort study of adult patients transported to one of two tertiary care centre EDs. Physicians completed a data collection form for each patient regarding ACR availability and the perceived value of the ACR. This study began shortly after the implementation of a new electronic ACR (eACR) handover process (Round 1). To control for any confounding factors related to this new eACR handover process, the study was repeated 6 months after its implementation (Round 2).ResultsTotal of 869 forms were collected: 545 in Round 1, and 324 in Round 2. The ACR was available at first physician assessment for 82 (15.7%) patients in Round 1, and 76 (24.4%) patients in Round 2 (Δ8.7%, 95% CI: 3.1%, 14.5%). The ACR was available at some point during patients’ ED stay for 154 (28.9%) patients in Round 1, compared to 111 (34.5%) patients in Round 2 (Δ5.6%, 95% CI: 0.0%, 12.1%). When the ACR was available for a patient (n=265), physicians believed that information in the ACR changed their treatment plan in 76 (28.8%) cases.ConclusionPhysicians who review the ACR believe that the ACR contains relevant information that may influence patient management; however, physicians commonly manage patients without reviewing the ACR.

scholarly journals Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 270-278
Author(s):  
Qamar Amin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell ◽  
Subhra Mohapatra ◽  
Abdulaziz Alsadoon ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulmonary Embolism ◽  
Oxygen Saturation ◽  
Tertiary Care ◽  
Heart Rate Change ◽  
Rate Change ◽  
Walk Test ◽  
Tertiary Care Centre ◽  
Absolute Decrease ◽  
Minute Walk

AbstractObjectiveDiagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism.MethodsThis was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism.ResultsWe enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0).ConclusionIn summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules.

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