Overall complication rates: The overall complication rates of ERCP in published trails vary from 4% to 15.9% with procedure-related mortality ranging from 0% to 1%. (Cheng et al., 2006). The incidence of major complications is ranging from 4% to 5%. Comparison of complication rates a mong trials can be difficult because of heterogeneity in study design and among study populations. Even in the more recent rails, which attempt to use consensus definitions of complications, there is significant variability in reported complication rates a nd associated risk factors (Jeremy, 2008). Higher short-term complication rates are not associated with increasing American Society of Anesthesiologist (ASA) score and ERCP is safely performed in elderly …show more content…
Bleeding may complicate ES in as many as 2% to 12% of cases. Although this usually manifests immediately and intraprocedurally, bleeding can be delayed by hours to days. Risk factors for post-ES bleeding may include coagulopathy or recent anticoagulation, cholangitis, cirrhosis, periampullary diverticulum, stone impaction and ampullary tumor. Treatment options for post-ES bleeding include conservative supportive measures, endoscopic hemost asis, angiographic embolization and surgery (Janak et al ,2010). (2) Perforation; ERCP-related perforation occurs in 0.1 -1.8% of patients after therapeutic ERCP. It is a serious complication with a high mortality rates. Delayed diagnosis and intervention are associated with a high mortality. Death following ERCP-related perforation is usually related to sepsis and multi-organ dysfunction. The presence of duodenal perforation in a patient with coexisting sepsis due to cholangitis or pancreatitis further increases the management difficulty (Lau and Eric, 2008). ERCP-associated perforations of the esophagus, stomach or duodenum distant from the ampulla are all caused by the endoscope. Peri-ampullary retroperitoneal perforations usually are caused by ES or result from bile duct injuries related to instrumentation with a wire or basket (Suissa et al, 2005). Perforations can be classified into four types: Type I: lateral or medial duodenal wall perforation, Type II: peri- Vaterian injuries, Type
HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around
History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and
Ann Hayes, age 68, initially was admitted to the hospital for elective surgical repair of an abdominal aortic aneurysm. Her surgery was documented as uneventful. However, complications developed during her 5th postoperative day as a result of a small bowel perforation.
Few days back, the patient had a CABG surgery and was send home under stable conditions. Family member noticed SOB and weakness from the patient and was directed to attend the ED. As they got to the ED, the emergency department nursing staff noticed SOB with pericardial hematoma and immediate drainage was necessary. A chest tube was placed as a treatment option.
The patient had a medical history of hypertension, hyperlipidemia, coronary artery disease, myocardial infarction in 2010, COPD, pulmonary embolism, prostate cancer, gastro esophageal reflux disease, and small bowel adhesions. The patient had an echocardiogram six months ago with an ejection fraction of 45%. Individuals with “an EF of 25% to 50% have an intermediate risk for the development of postoperative low cardiac output
C. Using what you’ve learned about word parts, describe the types of surgeries listed in the patient’s past surgical history.
T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips
Case fatality rate can be as high as 30% for untreated patients. With quick diagnosis and proper treatment fatalities are extremely rare. The most
• Various levels of concern are raised about high outlier hospitals, and suggestions are forwarded regarding internal and external reviews to verify and improve outcomes of surgery at these hospitals.
The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another
The second identified area where the process broke down was when the patient’s family called the hospital to tell them that she was having emesis and severe pain rated nine out of ten. The triage nurse instructed them to take Tylenol and informed them that the physician was unavailable. The physician eventually called back and instructed them to give her one Tylenol and some soup. In this stage, the physician downplayed the concerns and did not consider the possibility of pancreatitis, the most frequent complication after having had an ERCP (Johnson, Haskell, & Barach, 2016, p. 80). The
1. Cisco suffered from inertia when an attempt was made to engage business management in selecting software for their individual areas, and/or agreeing to participate in the ERP implementation project. List and explain reasons why management would hesitate to become engaged in the IT process/project.
The patient had a sudden onset of lower left quadrant pain and was diagnosed with
Multidisciplinary teams must be used to ensure that transition of care measures are completed. Some patient factors that are predictors of readmission due to rebleeding are features of shock at presentation; melena; age > 60 years; associated comorbidities like heart, liver or renal failure; larger ulcer size; stigmata of recent hemorrhage on endoscopy(11). Some factors in care that are predictors of readmission include early discharge within 72 hours for high risk patients, inadequate PPI dosage, insufficient discharge
They faced challenges from acquiring many companies because during the acquisitions Bombardier inherited the data, processes and systems of each company which created inefficiencies. Systems didn’t communicate with each other resulting in low inventory turns and price inconsistency. This was not productive for Bombardier and was time consuming for the employees. The biggest problem was the low visibility of inventory and the lack of communication between systems. Bombardier had now a global presence but was not organized to maintain growth without changing the vision and processes. Another challenge is resistance to change, this factor can have a huge impact on the new vision and