Experience of a surgeon at the emergency department during COVID-19 pandemic

Abstract

Introduction The COVID pandemic, which started on 11th March as per the World Health Organization, has resulted in a drastic change in health care delivery, including emergency services. Most health workers have deviated towards COVID care delivery; only a few were available for non-COVID conditions. All elective and non-essential services were postponed resulting in the increased burden of the emergency department. The emergency department had to provide essential emergency care with available staff without exposing them to the virus. Triaging of the patients was modified according to the needs. Methods The statistics of the emergency department of this period (April and May 2020) are compared with the same period of previous years (2018–2019) with the number of patients, indications, and complications. The methods of triaging and preparation were discussed. Discussion The number of patients admitted to the emergency department (ED) was low during the COVID pandemic. Nevertheless, they got admitted with complications due to delay in accessing the health care facility. Patients with diabetic foot ulcers were also presenting late, leading to an increased number of the forefoot and below knee amputations. In trauma, the emergency department has maintained the same death rate as previous years by giving great care. The indications for tracheostomy were worrisome because it would have been prevented if the patients presented early. Pediatric patients were also presented late, resulting in increased mortality. Some cancer patients also presented with a complication in the emergency department because of the postponement of elective surgeries. Conclusion There is a delay in accessing the health care delivery for non-COVID conditions resulting in more amputations of limbs and resections of the bowel. So the type of care in the emergency department was changed due to atypical presentation and complicated cases. It is necessary to ensure the provision of high quality health care delivery to non-COVID patients also.

Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?–A retrospective multicenter study

“…These efforts to minimize unnecessary traffic through the healthcare facility resulted in a significant reduction in emergency department patient encounters [ 12 , 13 ]. Significant increases in delayed care for different medical emergencies, including pediatric surgical emergencies, during the COVID-19 pandemic period has been noted by the medical community and published in several reports [ 8 , 9 , 10 , 11 , 12 , 13 ].…”

“…During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature [ 8 , 9 , 10 , 11 , 12 ]. Pediatric patients do not commonly experience medical conditions with a high risk of mortality but delay in diagnosis can lead to a significant increase in morbidity, prolonged hospitalization, increased financial expense and mortality [ 12 ].…”

Disparities in excess deaths from the COVID-19 pandemic among migrant workers in Kuwait

“…Second, delayed presentation – either due to personal fear of contracting the virus or difficultly accessing the healthcare system, is associated with more extensive disease presentation and therefore requires more aggressive interventions. For instance, a rise in surgical emergencies such as obstructed hernia with bowel ischemia, diabetic foot ulcers requiring amputation and appendicular abscess was noted during this pandemic [ 30 ]. Another example is the presentation of complications in oncological patients that have arisen due to the temporary halt of elective surgeries [ 30 ].…”

Disparities in Excess Deaths from the COVID-19 Pandemic Among Migrant Workers in Kuwait

“…Second, delayed presentation –either due to personal fear of contracting the virus or difficult access to healthcare, is associated with more extensive disease and therefore requiring more aggressive intervention. For instance, a rise in surgical emergencies such as obstructed hernia with bowel ischemia, diabetic foot ulcers requiring amputation and appendicular abscess was noted during this pandemic(25). Another example, patients with oncological conditions presented with complications and that can be attributed to the temporary stop of elective surgeries(25).…”

“…For instance, a rise in surgical emergencies such as obstructed hernia with bowel ischemia, diabetic foot ulcers requiring amputation and appendicular abscess was noted during this pandemic(25). Another example, patients with oncological conditions presented with complications and that can be attributed to the temporary stop of elective surgeries(25). The same can be said regarding medical emergencies, it was observed that delayed presentation of myocardial infarction is associated with higher mortality and more complication such as left ventricular free wall rupture (which tends to be fatal) and necrosis(26,27).…”