Emergency Care

Pulmonary Embolism Presenting As Shoulder and Back Pain: A Case Report (2024)

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Type of publication:
Journal article

Author(s):
*Nwaneri, Chukwuemeka; *Race, Rebecca; *Oladele, Romoluwa; *Kumaran, Subramanian.

Citation:
Cureus. 16(7):e64016, 2024 Jul.

Abstract:
Pulmonary embolism (PE) is a common but life-threatening condition, and diagnosis can be challenging. Diagnosis is even more difficult in those patients with atypical presentations such as the absence of pleuritic chest pain, dyspnoea, tachycardia, or symptoms of deep vein thrombosis. We have delineated shoulder and back pain as an atypical sign of PE. However, the significant amount of misdiagnosis highlights the importance of other rare symptoms of this potentially fatal disease. Therefore, eliciting these rare presenting symptoms can significantly reduce morbidity and mortality. Here, we report the case of a patient who, 13 days after a laparoscopic Nissen fundoplication, presented to the emergency department (ED) with left shoulder and left-sided pleuritic back pain. She was managed in the resuscitation area in the ED and was subsequently diagnosed with a left-sided PE. Her care was taken over by the medical team, and she continued her recovery in the acute medical unit.

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A QIP on the completion of the AMHT Form in the Emergency Department in SaTH (2024)

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Type of publication:
Service improvement case study

Author(s):
*Kallum Claire

Citation:
SaTH Improvement Hub, April 2024

Abstract:
I aim to improve completion of the adult mental health triage form in SaTH ED by 20% by 31/05/2023 through the use of a poster, which will highlight the necessity of completion as well as serving as a reminder for staff to complete paperwork in the correct manner.

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Improvement to assessment and provision of analgesia for patients with suspected Neck of Femur Fracture in ED (2023)

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Type of publication:
Service improvement case study

Author(s):
*Oleg Lujanschi

Citation:
SaTH Improvement Hub, November 2023

Abstract:
To improve the assessment and provision of analgesia (where required) for patients presenting in ED with a suspected Neck of Femur Fracture to ensure all patients meet the national standard by 15 December 2023. Additionally, the aim is to improve the percentage of patients who receive an x-ray when presenting to ED with a suspected Neck of Femur Fracture in line with the national standard of 90 minutes by 15 December 2023.

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Exploring the Impact of Interhospital Transfers on Patients Who Are Managed Conservatively Following Traumatic Spinal Injury: A Scoping Review (2022)

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Type of publication:
Conference abstract

Author(s):
*Nedham M.

Citation:
British Journal of Surgery. Conference: ASiT Surgical Conference 2022. Aberdeen United Kingdom. 109(Supplement 6) (pp vi132), 2022. Date of Publication: September 2022.

Abstract:
Introduction: Traumatic spinal injury (TSI) is a devastating event that could lead to serious permanent disability to patients. Therefore, a multidisciplinary team is needed to manage such cases. In the UK, patients with a TSI score a minimum of 16 on the Injury Severity Score (ISS) and are transported to a Major Trauma Centre (MTC). In cases where patients initially present to a none MTC, patients are stabilised and transferred to MTC prominently. Specialised Spinal Cord Units (SCIU) are centres specialised in the definitive management of TSI patients and it is advised that patients get referred to SCIU in a timely manner as studies demonstrate improved patient outcomes. Early transfers are recommended due to the positive impact of early surgical decompression of the injury, which relieves the pressure on the neural tissue. Nevertheless, is this impact still positive if patients are managed conservatively? Aim: To explore the impact of intermediate interhospital transfers on TSI patients when no surgical intervention is taking place. Method(s): A scoping review is utilised to explore the research question. CINAHL, MEDLINE, Pubmed, Cochrane library and ASSIA were the search engines utilised. Result(s): The search resulted in 4,595 papers. 15 met the inclusion and exclusion criteria and included in the review. Conclusion(s): There are no studies that directly explored the impact of transfer on conservatively managed patients, and most of the studies were of low-quality evidence. Age, length of stay, mechanism of injury and cost were all explored as factors related to patients transfer status.

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Emergency management of neck stoma patients during the coronavirus pandemic: a national nurse survey (2021)

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Type of publication:
Journal article

Author(s):
Senior A.; *Chan J.; Brookes K.; *Jolly K.; *Darr A.; *Ameen R.

Citation:
British Journal of Nursing; Jun 2021; vol. 30 (no. 12); p. 742-746

Abstract:
BACKGROUND: Neck stoma patient care involves significant clinical complexity. Inadequate staff training, equipment provision and infrastructure have all been highlighted as causes for avoidable patient harm.
AIMS: To establish the perception of knowledge and confidence levels relating to the emergency management of neck stomas among UK nurses during the COVID-19 pandemic.
METHOD(S): A nationwide prospective electronic survey of both primary and secondary care nurses via the Royal College of Nursing and social media. FINDINGS: 402 responses were collated: 81 primary care and 321 secondary care; the majority (n=130) were band 5. Forty-nine per cent could differentiate between a laryngectomy and a tracheostomy; ENT nurses scored highest (1.56; range 0-2) on knowledge. Fifty-seven per cent could oxygenate a tracheostomy stoma correctly and 54% could oxygenate a laryngectomy stoma correctly. Sixty-five per cent cited inadequate neck stoma training and 91% felt inclusion of neck stoma training was essential within the nursing curriculum.
CONCLUSION(S): Clinical deficiencies of management identified by nurses can be attributed to a lack of confidence secondary to reduced clinical exposure and education.

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