Atraumatic limb pain in a child raises concerns in a medical setting. That is how a typical case of Brodie's abscess presents, having pain without any other symptoms of systemic illness. Assessment and investigations might also not reveal anything significant unless adequate imaging is done. Although Brodie's abscess has a very low rate of complications and morbidity/disability, it is important that such a presentation is assessed clinically with a diagnosis of Brodie's abscess in mind to ensure an uneventful and good outcome. We illustrate in this case report a similar presentation of an 11-year-old girl who had multiple visits to primary care. She was then assessed through radiological imaging. By the time of her diagnosis, her abscess had protruded through the skin. Thankfully management was done swiftly after identification and the final outcome was good with complete recovery.
Anesthetic management of patients with dilated cardiomyopathy (DCM) can be challenging for anesthesiologists because it is associated with high perioperative mortality rate. This case report describes successful management and important anesthetic considerations in a 15-year-old boy, a known case of burn-associated dilated cardiomyopathy, who underwent bilateral ectropion correction surgery. In such patients, it is imperative to have meticulous preoperative planning, wise selection of medications, and tailored anesthetic technique in order to achieve a favourable outcome. Key words: Anesthesia; Burns; Cardiomyopathy, Dilated; Ketamine; Propofol; Dopamine Citation: Sheikh N, Salik M, Faraz A, Aldahish MM. Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion. Anaesth. pain intensive care 2020;24(5): Received: 22 August 2020, Reviewed: 23 August 2020, Accepted: 28 August 2020
Aim To assess the effect of COVID 19 on ward notes documentation standards Method 100 ward notes entries (before COVID, during COVID Peak, and after COVID Peak, 100 each) were evaluated against set ward notes documentation standards derived from the GMC Good Medical Practice document. The results were analysed, and the three data sets were compared to assess any effect of the COVID 19 pandemic on ward notes documentation standards. Results Individually, clear handwriting and documenting signatures showed a slight decline, and a slight increase was seen in the use of unknown abbreviations during the COVID-19 Peak. However, documentations standards were maintained across other categories and even showed improvement in some standards. Overall compliance showed a small improvement rather than a decline during the COVID 19 Peak. Conclusions COVID 19 Pandemic has certainly had an effect on every aspect of life globally. The health sector came under significant pressure and saw unprecedented stressful working conditions during the peak of the pandemic. However, even under the unprecedented pressures of COVID 19, we were able to maintain remarkable documentation standards and even showed improvements across various standards. It should be kept in mind that there are limitations to this Audit and further studies are needed to confirm these findings.
Aim To improve the assessment, documentation, and management of suspected Cauda Equina Syndrome (?CES) referrals by supporting and educating new doctors joining T&O Method A survey was done to assess the level of training received by Junior Doctors in Assessment, Documentation, and Management of a ?CES Referral. A need for such training was established from the Survey Report. Teaching was organized and an Infographic poster was published to aid new doctors in safe assessment, documentation, and management of? CES cases. A post Survey was done to assess the impact. Results There was a significant need for teaching and training regarding the approach towards dealing with a suspected Cauda Equina Syndrome patient. The teaching was very well received. 90% of the participants believed that the QIP and the infographic poster were useful in training, will be a helpful guide for new doctors in assessment, documentation, and management of suspected Cauda Equina Syndrome patients, and will lead to improvement in patient care and documentation. Conclusions Suspected Cauda Equina Syndrome bears a huge significance in Emergency Care and Trauma and Orthopaedics. Mismanagement of such a case and unnecessary delays can have a drastic impact on a patient’s life and as such can also lead to significant medico-legal implications from the managing team. Teaching and training regarding approach towards a suspected Cauda Equina Syndrome can lead to significant improvement in the competence and confidence of the Junior Doctors and New Trainees and thus lead to better patient care, better documentation standards, and potentially prevent unnecessary delays.
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