Læknablaðið : fylgirit - 15.06.2002, Síða 17

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
POSTERS
P 01 - Wounds and other common emergencies
The use of a chair to reduce anterior shoulder dislocation
Wright KD
John Radcliffe Hospital, Oxford, UK
Objective: Dislocated shoulder is a common problem presenting to
the Emergency Department. Standard reduction utilises sedation
and analgesia in order to provide muscle relaxation. This can be
time consuming and requires a period of post-procedural obser-
vation and discharge in the care of a responsible adult. In this poster
we describe a method a reduction that uses a modified chair and
requires no sedation. The results of two years of experience are
described.
Method: Data was recorded over a two-year period for each
shoulder dislocation that had "the chair method" used. Patients are
selected for the chair if they are able to comply with the seating
position and are not requiring large doses of opiate for analgesia.
Success or failure was documented along with complications. This
data was analysed together with the patient's records. This data was
studied retrospectively and patient's attendance cards were
collated. Also noted from computer records were department
demographics at the time such as workload and staffing.
Results: During the study period 35 reductions were attempted
using the chair method. 29 of these were successful. Of the six
faiiures 1 had fracture dislocation, 1 had recurrent dislocation and
was on his 4th presentation. 4 of the successes were carried out in
the same 30 minute period.
Conclusion: In selected cases the chair method provides an easy,
sedation free shoulder reduction. Operator experience will
determine the choice of reduction method. Traditional methods are
still required if the chair method fails or the patient is not suitable.
P 02 - Ultrasound in the ED
An unusual cause of acute renal failure: the role of ultrasound
examination: case report
Ruggiano G
S. Maria Annunziata Hospital, Florence, Italy
Case report: An 80 year old man was admitted to the hospital for
mild dyspnoea and diffuse abdominal pain. The patient had
suffered from hypertension for more than 20 years and 10 years
previously had had myocardial infarction and two ischaemic
strokes, with a good functional recovery. Five years before the
admission, a non-Hodgkin's lymphoma was diagnosed. He under-
went chemotherapy and radiotherapy with partial control of the
disease bulk. During the same period an ultrasound examination of
the abdomen showed a 5 cm diameter abdominal aortic aneurysm.
On physical examination the patient appeared mildly dyspnoeic,
abdominal examination showed mild abdominal tenderness, no
palpable mass, an abdominal aortic bruit was heard. Oedema of the
lower limbs was evident. His temperature was 36.5°C, blood
pressure was 130/70 mmHg. HR 80 bpm. The Sat02 was 88% on
rooni air, but on 02 therapy the blood gas analysis showed a Pa02
of 86 mmHg, PaC02 41.6 mmHg, Sat02 97%.
Blood analysis showed a normocytic, normochromic anaemia,
high creatinine and urea levels, hyperkalemia, and no elevation of
cardiac or hepatic enzymes. Urine analysis showed proteinuria and
haematuria, with hyaline casts. Chest x-ray showed mediastinal
lymphadenopathy which narrowed the tracheal lumen. Ultrasound
examination of the abdomen showed an enormous aortic aneurysm
(8-9 cm in diameter) with a double lumen and an evident point of
dissection at the level of renal arterial branching. Furthermore,
there was an arteriovenous fistula between the aortic aneurysm and
the inferior vena cava, which was squeezed by the aortic aneurysm
and the retroperitoneal lymphadenopathy. CT scan confirmed all
the ultrasound findings, showing lymphadenopathy both in the
mediastinum and in the retroperitoneal space, as well as an aneu-
rysmatic aorta from the diaphragm to the common iliac arteries
with a double lumen and a communication between the abdominal
aortic aneurysm and the inferior vena cava. The CT scan also
showed subocclusion of both renal arteries. Over one day creatin-
ine and potassium levels continued to rise and the patient deve-
loped progressive shock, ending ultimately in cardiac arrest. Due to
the compression of the caval venous system by the abdominal and
chest lymphadenopathy, the arteriovenous fistula did not result in
pulmonary hypertension, nor in clinically evident mediastinal synd-
rome, or cardiomegaly on chest x-ray. Thus, apart from a mild
dyspnoea as the main clinical symptom, the patient remained
paradoxically in haemodynamic steady-state until death.
P 03 - ED Systems: Efficiency, Productivity
Patient satisfaction versus patient gender: a survey of 10,637
emergency department patients
Allegra JR, Cochrane DG, Eskin B, Cable G
Morristown Memorial Hospital Residency in Emergency Medicine, United States
Objective: To determine if there is a difference in emergency
department (ED) patient satisfaction scores associated with patient
gender in a large database.
Methods: Design: Retrospective cohort of non-admitted ED
patients. Setting: Multiple New Jersey, USA EDs. Participants: Con-
secutive patients who responded to a standardized mail anonymous
questionnaire which included five questions marked on a five point
scale, 5 being the most satisfied. Patients who responded with a 4 or
5 were considered “very satisfied”. Patient responses were grouped
according to patient gender and analyzed for differences using
logistic regression analysis controlling for hospital where care was
provided, physician gender, physician age and severity of illness. A
p value of < 0.05 was taken to be statistically significant.
Results: We analyzed 10,637 surveys. We found for three of the
questions, female patients were less likely to be “very satisfied”
than males: “Doctor took problem seriously” 14% less likely [Odds.
ratio (OR) = 0.86, 95% confidence intervals (95% CI) = 0.75 to
0.97, (p=0.01)],“Doctor'sconcern forcomfort” 12% less likely [OR
= 0.88, 95% CI = 0.78 to 0.99, (p=0.04)], and “Doctor informalive
regarding treatment” 12% less likely |OR = 0.88, 95% CI = 0.78 to
0.98, (p=0.02)]. For the other questions, “Doctor's Courtesy” and
“Waiting time to see doctor”, there were no statistically significant
differences.
Conclusion: There is a difference in ED patient satisfaction scores
associated with patient gender. Female patients were less likely
Læknablaðið/Fylgirit 45 2002/88 17