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Relevant bibliographies by topics / Acute surgical unit

Academic literature on the topic 'Acute surgical unit'

Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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Journal articles on the topic "Acute surgical unit"

1

Page, Dean E., Dilshad Dooreemeah, and Dhan Thiruchelvam. "Acute surgical unit: the Australasian experience." ANZ Journal of Surgery 84, no. 1-2 (November 28, 2013): 25–30. http://dx.doi.org/10.1111/ans.12473.

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Von Conrady, Dora, Saud Hamza, Dieter Weber, Koorush Kalani, Krishna Epari, Marina Wallace, and David Fletcher. "The acute surgical unit: improving emergency care." ANZ Journal of Surgery 80, no. 12 (October 1, 2010): 933–36. http://dx.doi.org/10.1111/j.1445-2197.2010.05490.x.

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Kinnear, Ned, Eliza Bramwell, Alannah Frazzetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, and James Moore. "Acute surgical unit improves outcomes in appendicectomy." ANZ Journal of Surgery 89, no. 9 (April 15, 2019): 1108–13. http://dx.doi.org/10.1111/ans.15141.

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Cox, Michael R., Lyn Cook, Jennifer Dobson, Paul Lambrakis, Shanthan Ganesh, and Patrick Cregan. "Acute Surgical Unit: a new model of care." ANZ Journal of Surgery 80, no. 6 (June 1, 2010): 419–24. http://dx.doi.org/10.1111/j.1445-2197.2010.05331.x.

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Blucher, Kristopher M., Samuel E. Dal Pra, James Hogan, and Arkadiusz Peter Wysocki. "Ward safety checklist in the acute surgical unit." ANZ Journal of Surgery 84, no. 10 (December 16, 2013): 745–47. http://dx.doi.org/10.1111/ans.12496.

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Bazzi, Zacharia T., Ned Kinnear, Ciara S. Bazzi, Derek Hennessey, Maciej Henneberg, and Greg Otto. "Impact of an acute surgical unit on outcomes in acute cholecystitis." ANZ Journal of Surgery 88, no. 12 (September 11, 2018): E835—E839. http://dx.doi.org/10.1111/ans.14802.

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Suhardja, TS, L. Bae, EZ Seah, P. Cashin, and DG Croagh. "Acute surgical unit safely reduces unnecessary after-hours cholecystectomy." Annals of The Royal College of Surgeons of England 97, no. 8 (November 1, 2015): 568–73. http://dx.doi.org/10.1308/rcsann.2015.0035.

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Introduction The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care. Methods A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm – 8am), length of stay and surgical complications. Results A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar. Conclusions Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay.

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Bown, Matthew J., M. G. A. Norwood, I. M. Loftus, P. Spiers, and R. D. Sayers. "The Surgical Acute Care Unit (SACU): effects on surgical workload and mortality." ANZ Journal of Surgery 74, no. 10 (October 2004): 881–84. http://dx.doi.org/10.1111/j.1445-1433.2004.03194.x.

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Karahalios, Amalia, and Steven T. F. Chan. "Re: Ward safety checklist in the acute surgical unit." ANZ Journal of Surgery 85, no. 4 (April 2015): 295. http://dx.doi.org/10.1111/ans.12994.

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Wang, Edward, Ravish Jootun, and Amanda Foster. "Management of acute appendicitis in an acute surgical unit: a cost analysis." ANZ Journal of Surgery 88, no. 12 (July 11, 2018): 1284–88. http://dx.doi.org/10.1111/ans.14727.

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Dissertations / Theses on the topic "Acute surgical unit"

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Costanzo, Amy J. "The Culture of Interprofessional Collaborative Practice on Two Adult Acute-Care Medical-Surgical Units." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1490699191549097.

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Aulbach, Rebecca K. "Nurses' practices with blood transfusions in medical-surgical patient care units of acute care U.S. hospitals the state of the science." Thesis, Texas Woman's University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3598453.

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Blood transfusions occur in all areas of a hospital with nurses at the point-of-care responsible for specimen collection, blood administration, patient surveillance, and adverse event reporting. Unfortunately there is a paucity of nursing research on blood transfusions. The purpose of this study was to describe the state of the science of medical-surgical acute care nurses' practices with blood transfusion therapy. Seven research questions addressed the comprehensive scope of nurses' involvement with blood transfusions. Data was collected via a valid and reliable web-based survey, Nurses' Practices with Blood Transfusions: Medical-Surgical Acute Care. A random selection of U.S. hospitals with a nurse executive who was a member of the American Organization of Nurse Executives was recruited via postal letter. One survey was completed per hospital with 148 hospitals responding (18.3% response rate).

Nurses' practices in transfusion processes are similar across the country. The hospital's transfusion policy was the most influential source of information for nurses because it specified nurses' transfusion practices. Limitations in surveillance of the medical-surgical patient with a blood transfusion were due to the lack of current information on transfusion reaction symptoms included in the education programs, delegation of transfusion vital signs to non-licensed staff that were not educated on symptoms of a transfusion reaction and transportation of patients with blood infusing to tests and procedures. Hospitals were in the process of adopting electronic technologies to reduce or eliminate wrong-blood-in-tube errors or wrong blood administered mistransfusion errors. Nurses need to collaborate with the transfusion service to update the transfusion policy and the blood transfusion education programs; include non-licensed staff in compulsory blood transfusion education; and closely evaluate the capabilities of an electronic documentation system to truly match the patient to the blood product. This descriptive study is a foundation for future research of nurses with blood transfusions.

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Hudson, Sonia A. "Systematic Literature Review on Fall Prevention in an Acute Care Hospital Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7874.

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Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.

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El, Halal Michel Georges dos Santos. "Morbimortalidade relacionada à disfunção renal aguda estimada pelo critério pRIFLE em crianças submetidas a cirurgia cardíaca." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/95370.

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Objetivos: O objetivo deste estudo foi investigar associação entre ocorrência de disfunção renal aguda de acordo com o critério RIFLE pediátrico (pRIFLE) e desfechos negativos em crianças em pós-operatório de cirurgia cardíaca. Métodos: Crianças submetidas à cirurgia cardíaca em um hospital terciário no sul do Brasil foram acompanhadas da internação até a alta da Unidade de Terapia Intensiva Pediátrica (UTIP) ou óbito. A variável de exposição foi ocorrência de disfunção renal aguda de acordo com o critério pRIFLE, que divide disfunção renal aguda em 3 categorias: R-Risco, I-Lesão, F-Insuficiência. Os desfechos estudados foram morte, tempo de ventilação mecânica (VM) e tempo de internação na UTIP. Resultados: Oitenta e cinco crianças foram estudadas. Quarenta e sete (55,3%) não desenvolveram disfunção renal aguda durante a internação na UTIP, enquanto que 22 (25,9%), 7 (8,2%) e 9 (10,6%) foram classificadas nos grupos R, I, e F, respectivamente. A incidência de óbito foi de 18,4% e de 4,2% nos pacientes com e sem disfunção renal aguda, respectivamente. Comparado a crianças que não desenvolveram disfunção renal, a razão de chances ajustada de óbito foi 1,046 (0,09-11,11), 8,358 (1,32-52,63) e 7,855 (1,53-40,29) nos grupos R, I, e F, respectivamente (p = 0,022). Os tempos de VM e de internação na UTIP foram significativamente maiores nas crianças com disfunção renal aguda. Conclusões: Ocorrência de disfunção renal aguda de acordo com o critério pRIFLE está associado com maior morbidade (maior tempo de VM e de internação na UTIP) e maior mortalidade em crianças em pós-operatório de cirurgia cardíaca.
Objectives: This study aims to investigate association between occurrence of acute kidney injury (AKI) according to pediatric RIFLE (pRIFLE) criteria and adverse outcomes in children after heart surgery. Methods: Children submitted to open heart surgery in a tertiary hospital in Southern Brazil were followed from arrival until discharge from the Pediatric Intensive care Unit (PICU) or death. The exposition variable was occurrence of AKI according to pRIFLE criteria, which divides AKI in three categories: R-Risk, I-Injury, F-Failure. The outcomes studied were death, length of mechanical ventilation (MV) and length of PICU stay. Results: Eighty five children were studied. Forty seven (55.3%) did not have AKI during PICU stay, while 22 (25.9%), 7 (8.2%) and 9 (10.6%) were classified as R, I and F, respectively. The incidence of death was 18.4% and 4.2% in patients with and without AKI, respectively. Comparing to children who did not develop AKI, the adjusted odds ratio for death was 1.046 (0.09-11.11), 8.358 (1.32-52.63) and 7.855 (1.53-40.29) in the R, I and F group, respectively (p = 0.022). Lengths of MV and of PICU stay were significantly higher in those with AKI. Conclusions: Occurrence of AKI according to pRIFLE criteria is associated to adverse outcomes in children after open heart surgery.

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Kinnear, Ned John. "Impact of the Acute Surgical Unit on a Local and Global Scale." Thesis, 2022. https://hdl.handle.net/2440/135912.

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Introduction Traditionally, general surgical departments allocated their staff to elective operative and outpatient commitments, with emergency general surgical (EGS) patients managed ad-hoc. An acute surgical unit (ASU) model was pioneered in 1996 and spread globally. However, uptake remains slow, in part due to clinical equipoise. This thesis aims to address key gaps in the literature, to support hospitals considering establishing an ASU and EGS policymakers. Methods Locally, three retrospective studies were performed at the Lyell McEwin Health Service. For patients with appendicitis or cholecystitis, these compared cohorts ≤2.5 years pre/post ASU introduction. Primary outcomes were length of stay, time to theatre, after-hours operating rates, rates of cholecystectomy on index admission and rates of appropriate communication and management of incidental pathology (appendicitis patients only). A fourth study prospectively assessed patient reported outcomes within the Royal Adelaide Hospital ASU. Primary outcomes were factors associated with patient satisfaction on multivariate analysis. Nationally, two studies reported the results of a cross-sectional assessment of the general surgery departments in all medium-large sized Australian public hospitals. Primary outcomes were the spectrum of EGS models in use, staff satisfaction and operative exposure. Globally, two systematic reviews were performed. The first identified ASU-type dedicated models of care for emergency patients in urology. The primary outcome was the spectrum of models. The second collated for meta-analysis general surgery studies comparing the Traditional and ASU models. Primary outcomes were length of stay, cost and rates of after-hours operating and complications. Results Locally, single centre retrospective studies of 319–1,214 patients found that establishing an ASU was associated with reduced time to theatre and rates of after-hours operating, and superior rates of cholecystectomy on index admission. Length of stay was reduced for patients with cholecystitis but not appendicitis. For presumed-appendicitis patients with incidental pathology, rates of communication or appropriate management were unchanged. Nationally, the cross-sectional study enrolled 119/120 eligible hospitals. Sixty-four (54%) hospitals reported using an ASU or hybrid EGS model. Compared with the Traditional structure, hybrid or ASU models were associated with greater surgeon and registrar satisfaction. Registrar-perceived operating exposure was unaffected by EGS model. Globally, the first systematic review identified seven centres implementing a variety of dedicated models for emergency urological patients. The second review enrolled 77 publications representing 150,981 unique EGS patients from thirteen nations. Compared with the Traditional model, ASU introduction was associated with reductions in length of stay and rates of after-hours operating and complications. Financial assessments found the ASU to deliver equivalence or cost savings. Conclusion Compared with the Traditional structure, the ASU model delivers superior outcomes. The ASU model should be promoted in health policy to benefit patients, staff and health budgets. Further improvements may involve ASU wards as centres of education and excellence, linked contractual obligation and increased funding for general surgeons to deliver EGS care and greater inter-hospital coordination. Future research includes cost analyses, quality improvement initiatives measured by patient reported outcomes and assessment of ASU model utility in other surgical specialties and in low-income countries.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2022

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HSIAO, Li Yu, and 蕭立伃. "Quality of Sleep and Acute Confusion among Elderly Patients in Surgical Intensive Care Units." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/75436976888646555681.

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碩士
輔英科技大學
護理系碩士班
101
As our country has entered the aging society, the proportion of the elderly population using medical resources has been gradually increasing. However, sleep problems are often prevalent pressure source in ICU. An ICU patient’s probability of occurrence of acute confusion is higher than that of a general inpatient. Currently, there is a lack of research, exploring the relevance of relationship between quality of sleep and acute confusion in an ICU in Taiwan. Accordingly, this triggers the motivation to explore it. This study aims to investigate the quality of sleep of elderly patients in the SICU, the incidence of acute confusion, the related factors and predictors of acute confusion. A descriptive correlational design was adopted. This study recruited patients, who aged 65 years or more and were transferred to ICU after the surgery and had been in ICU for more than 24 hours as subjects, totaling 136 people. The results showed that 88.24 percent of SICU patients had poor sleep quality one month before the surgery. Within 5 days after the surgery, there was an average of 4.40 hours of sleep at night. The average of nighttime sleep disruption was 8.79 times within five days after the surgery. The incidence of acute confusion was 79.41% and the incidence was the highest after one day of ICU stay, accounting for up to 33.1% of the population. The predictor of acute confusion was catheterization p-value, which was 0.004 （OR, 13.465）. The age p-value was 0.006 （OR, 1.203）. The pain index p-value was 0.006 （OR, 2.547）. PSQI score p-value was smaller than 0.001 （OR, 1.823）. These four variables are statistically significant and therefore can be the predictor for SICU elderly patients with acute confusion （R2 = 0.489）. It is hoped that this study can be used in clinical practice for early detection of high risk of acute confusion to prevent further damage so that ICU nurses can establish a care model that ensures sleep quality to prevent risk factors of acute confusion and improve the quality of elderly health care.

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Morency, Dominique. "Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada." Thèse, 2015. http://hdl.handle.net/1866/13875.

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Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.
Introduction : Les unités de soins aigus chirurgicaux (USAC) sont des unités dédiées à la prise en charge rapide des patients se présentant avec des urgences chirurgicales. Elles ont pour rôle de diviser le service de chirurgie générale afin d’organiser le système de garde en diminuant le conflit entre la prise en charge des urgences chirurgicales et les obligations électives. Nous avions pour objectif de définir les caractéristiques des USAC et de trouver des critères communs aux unités ayant rapporté un fonctionnement efficace et une bonne organisation. Méthodes : En date du 1er juillet 2014, vingt-deux hôpitaux canadiens rapportaient posséder une USAC. Un questionnaire comportant des questions sur l’organisation de leur USAC, la population desservie, le nombre d’urgences chirurgicales annuelles et la satisfaction en lien avec l’implantation de leur USAC leur a été envoyé. Résultats : Nous avons obtenu un taux de réponse de 73%. La majorité des hôpitaux étaient des centres tertiaires ou quaternaires, servaient une population de plus de 200 000 personnes et possédaient une USAC depuis plus de trois ans. Un nombre médian de 8,5 chirurgiens participaient à l’USAC et travaillaient en alternance sur une période de 7 jours. Le nombre médian de priorités opératoires était de 2,5 jours par semaine. La plupart des unités (85%) avait un nombre annuel estimé de plus de 2 500 consultations urgentes et 80% des unités opéraient plus de 1 000 cas par année. La grande majorité des répondants (94%) se disait satisfaite de la création d’une USAC dans leur hôpital. Conclusion : La majorité des chirurgiens affirme avoir vu un impact positif depuis la mise en place de l’USAC. Par contre, pour justifier la création d’une USAC, il semble nécessaire que soient présents un certain bassin de population, un nombre minimal annuel d’urgences chirurgicales ainsi qu’un certain nombre de chirurgiens y participant.

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Ku, Shu Fang, and 顧淑芳. "The effect of relaxation on the release of acute pain and state anxiety in postoperation patients in surgical intensive care units." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/06932750270631285031.

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碩士
輔仁大學
護理學系碩士班
94
The purpose of this experimental study was to investigate the effect of relaxation training on the release of acute pain and anxiety in post-operative patients in surgical intensive care units (ICU), and to understand the influence of relaxation on patients’ physical status and their hospitalized satisfaction. The convenience samples of 90 postoperative patients were recruited from the surgical ICU of a large medical center in North Taiwan. Subjects were randomized divided into two groups: 45 patients in the intervention group and the other 45 patients in the control group. Patients in the intervention group received the relaxation training twice a day, while patients in the control group received only routine nursing care. Data were collected by interview using a structured questionnaire including demographic data, Visual Analog Scale (VAS) pain scale, Hospital Anxiety and Depression Scale (HADS) - anxiety subscale, and the Hospitalized Satisfaction Scale. Data were analyzed using descriptive statistics, paired t-test, and generalized equation estimate (GEE). Results of this study included: 1. Patients suffered from moderate to severe degree of pain. Most of pain was caused by surgical wound. The level of pain was worsen by breathing, coughing, and moving body. 2. On the baseline data, there was no significant difference between the intervention group and the control group on the highest pain of a day (6.60±2.21 vs. 6.67±2.72) as well as in the average pain of a day (3.84±2.68 vs. 3.84±2.77). On the day of patients transferred out of ICU, the level of pain on both groups was decreased. However, there was no significant difference between both groups on the highest pain of a day (4.69±2.53 vs. 3.97±2.60) as well as on the average pain of a day (1.84±2.03 vs. 1.33±2.29). Thus, the relaxation training has no significant effect on reducing pain of postoperative patients in surgical ICU. 3. On the baseline data, both the intervention group and the control group had mild degree of anxiety (8.18±5.00 vs. 6.96±3.66). The intensity of anxiety on both groups was decreased on the day of patients transferred out of ICU (4.18±3.46 vs. 4.64±3.92). In additions, there was significant difference between both groups on the degree of reducing pain. Thus, the relaxation training had significant effect on reducing anxiety of postoperative patients in surgical ICU. 4. The hospitalized satisfaction score in the intervention group was higher than the control group. However, there was no significant difference between two groups. 5. The relaxation training contributed to the change of patients’ physical status by reducing systolic blood pressure 2.26 mmHg (p<0.05) and increasing finger’s temperature 0.71oC(p<0.001). This study confirmed that relaxation training had significant effect on reducing anxiety in postoperative patients in surgical ICU. It is suggested that relaxation could be performed to manage patients’ anxiety in ICU. Nurses should enhance their knowledge on relaxation for better quality of nursing care focusing on patients’ psychological needs.

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Books on the topic "Acute surgical unit"

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Jaggar, Siân, and Helen Laycock. Acute pain in the intensive cardiac care unit. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0073.

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◆ Cardiac intensive care units admit a heterogeneous patient group◆ Pain is common, occurring in up to 70% of medical and surgical patients◆ Effective analgesia is important◆ Pain is under-recognized and inadequately treated, particularly in medical patients◆ Consequences of pain are widespread, involving multisystem physiological changes◆ Pain causes significant psychological sequelae for patients, and ethical implications for physicians◆ Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires:○ Understanding of the potential causes of pain in cardiac intensive care○ Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects○ Employing a multimodal, multidisciplinary management strategy

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Jaggar, Siân, and Helen Laycock. Acute pain in the intensive cardiac care unit. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0073_update_001.

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◆ Cardiac intensive care units admit a heterogeneous patient group◆ Pain is common, occurring in up to 70% of medical and surgical patients◆ Effective analgesia is important◆ Pain is under-recognized and inadequately treated, particularly in medical patients◆ Consequences of pain are widespread, involving multisystem physiological changes◆ Pain causes significant psychological sequelae for patients, and ethical implications for physicians◆ Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires:○ Understanding of the potential causes of pain in cardiac intensive care○ Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects○ Employing a multimodal, multidisciplinary management strategy

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Marx, Gernot, and Michael Fries. Acute illness in the postoperative period. Edited by Neil Soni and Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0089.

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As more complex and risky surgical procedures are carried out in industrialized countries, anaesthetists are confronted with higher incidences of acute life-threatening conditions during the perioperative period. This is especially true for older patients with concomitant morbidities. Sepsis, cardiovascular complications including myocardial infarction, pulmonary embolism, and stroke, as well as massive bleeding are among the most severe complications that may arise during any time in the postoperative period starting as early as in the post-anaesthesia care unit. Early identification along with rapid stabilization of vital signs are key to improving outcomes in these patients.

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Khanna, Ashish K., and Piyush Mathur. Bariatric Surgery and Acute Cardiovascular Complications in the ICU. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0019.

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The increased numbers of bariatric surgical procedures worldwide have translated into a higher number of postoperative intensive care unit (ICU) admissions. The pathophysiologic perturbations in obesity mean that a large fraction of bariatric surgical patients have both diagnosed and undiagnosed underlying coronary artery disease, hypertension, cardiac rhythm disturbances, and baseline cardiac dysfunction. Manifestations of cardiac complications in this patient population are usually extremely subtle, both intraoperatively under anesthesia and in the ICU during the immediate postoperative period. Furthermore, the patients’ poor physiologic reserve does not allow for periods of hypoperfusion secondary to cardiovascular insufficiency. It is incumbent on the intensivist taking care of these patients to develop a specific skill set focused on early identification of cardiovascular complications in the postoperative period. This chapter highlights some specific cardiovascular complications in bariatric surgery patients, management of the complications, and recommendations for prevention, with a focus on some pertinent surgery-specific issues.

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Deen, Jason F., and Karen K. Stout. Therapeutic strategy in valvular problems. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0159.

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Valvular heart disease constitutes considerable disease burden in the elderly and surgery remains the definitive treatment. Most valve dysfunction is chronic in nature and may not meet sufficient criteria for surgical consideration; however, additional stressors such as hypovolaemia, arrhythmia, or infection may lead to cardiovascular symptoms and haemodynamic compromise, necessitating intensive care unit management. Acute valve dysfunction is typically a surgical emergency, and medical therapy is selectively used to bridge to more definitive therapy. Some situations, such as mitral stenosis, may be effectively medically managed to delay a surgical procedure, but the majority of acute valve dysfunction that requires intensive care will eventually come to surgery.

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Prasad, Raj K., and Imeshi Wijetunga. Hepatobiliary surgery (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198749813.003.0002.

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This chapter discusses common elective and emergency presentations to hepatobiliary surgery. Gallstone disease, being the commonest hepatobiliary condition encountered by general surgical trainees, is discussed in detail. A separate section on acute ascending cholangitis is included with a brief description of the steps involved in laparoscopic cholecystectomy. Acute pancreatitis is discussed in Pancreatic Surgery Chapter 3. An overview of the assessment and management of post-cholecystectomy complications, such as bile duct injury and vascular injuries, is provided with illustrations. Management of common malignant conditions of the liver, such as colorectal liver metastasis, hepatocellular carcinoma, and cholangiocarcinoma, is included with detailed discussion of pre-operative imaging. Liver resection surgery and liver transplant surgery, as well as non-surgical management, are discussed. Details of post-operative management of hepatobiliary patients are aimed at the junior surgical trainee working in a tertiary hepatobiliary unit to aid day-to-day management of post-operative patients on the wards, as well as subsequent follow-up.

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Walkey, Allan J., and David D. McManus. Causes and diagnosis of tachyarrhythmias. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0155.

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Tachyarrhythmias occur during approximately 12% of medical and surgical intensive care unit hospitalizations. The haemodynamic, metabolic, autonomic, inflammatory, and pharmacological factors associated with critical illness may act as arrhythmia triggers. The occurrence of new tachyarrhythmia in a critically-ill patient may be associated with an acute decrease in cardiac output, resulting in haemodynamic instability, an event that often results in increased morbidity and mortality. Accurate electrocardiographic arrhythmia diagnosis is necessary for instituting effective therapy. This chapter reviews the various strategies for identifying the causes, and obtain accurate diagnosis for supraventricular and ventricular tachyarrhythmias that commonly occur during critical illness.

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Craig, Anne, and Anthea Hatfield. The Complete Recovery Room Book. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198846840.001.0001.

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New technologies are increasingly available for patient care but simple ‘tried and true’ old fashioned methods are still essential. The care that a patient receives in the first hours after surgery is crucial to minimizing the risk of complications such as heart attacks, pneumonia, and blood clots. As the patient awakes from their drug-induced coma, it takes time for them to metabolize and excrete drugs. They remain unable to care for themselves, and are at increased risk of harm. The recovery room staff must manage both comatose and physiologically unstable patients and deal with the immediate postoperative care of surgical patients. The sixth edition of this popular book, introducing a new author Dr Anne Craig, will provide nurses, surgeons and anaesthetists guidance on how to manage day-to-day problems and make difficult decisions. Previous editions of this book have established it as the definitive guide to setting-up, equipping, staffing, and administering an acute care unit. Basic science, physiology and pharmacology are fully explained. There are chapters on specific symptoms including pain and vomiting, and chapters devoted to the unique postoperative needs of individual types of surgery. This new edition brings this important text up to date and new drugs and techniques for monitoring are described. A new section looks ahead to the future development and design of recovery rooms and how they can contribute to patient well-being.

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Subhas, Kamalakkannan, and Martin Smith. Intensive care management after neurosurgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0369.

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The post-operative management of neurosurgical patients is directed towards the prevention, prompt detection, and management of surgical complications, and other factors that put the brain or spinal cord at risk. Close monitoring is required in the first 6–12 post-operative hours as deterioration in clinical status is usually the first sign of a potentially fatal complication. The majority of patients do not require complex monitoring or management beyond the first 12 hours after elective surgery, although prolonged intensive care unit management may be required for those who develop complications, or after acute brain injury. Cardiovascular and respiratory disturbances adversely affect the injured or ‘at risk’ brain, and meticulous blood pressure control and prevention of hypoxia are key aspects of management. Hypertension is particularly common after intracranial neurosurgery and may cause complications, such as intracranial bleeding and cerebral oedema, or be a consequence of them. A moderate target for glycaemic control (7.0–10 mmol/L) is recommended, avoiding hypoglycaemia and large swings in blood glucose concentration. Pain, nausea, and vomiting occur frequently after neurosurgery, and a multimodal approach to pain management and anti-emesis is recommended. Adequate analgesia not only ensures patient comfort, but also avoids pain-related hypertension. Disturbances of sodium and water homeostasis can lead to serious complications, and a structured approach to diagnosis and management minimizes adverse outcomes. Post-operative seizures must be brought rapidly under control because of the risks of secondary cerebral damage and/or progression to status epilepticus.

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Using a Model of Clinical Events to Determine Supply Requirements for Marine Corps Shock Surgical Team/Triage (SST) and Acute Care Ward Units. Storming Media, 1998.

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Book chapters on the topic "Acute surgical unit"

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Sonnaike, Emmanuel, and Jeremy L. Ward. "Surgical Procedures in the Intensive Care Unit." In Common Problems in Acute Care Surgery, 55–62. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-42792-8_5.

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Dultz, Linda A., Vasiliy Sim, and S. Rob Todd. "Surgical Procedures in the Intensive Care Unit." In Common Problems in Acute Care Surgery, 59–71. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-6123-4_5.

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Töns, Ch, U. Klinge, H. Kierdorf, and V. Schumpelick. "Postoperative Acute Renal Failure in Surgical Intensive Care Units." In Die Chirurgie und ihre Spezialgebiete Eine Symbiose, 169. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-95662-1_84.

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Chipman, Jeffrey. "Acute Pancreatitis in the Surgical Intensive Care Unit." In Surgical Critical Care, Second Edition, 569–81. CRC Press, 2005. http://dx.doi.org/10.1201/b14532-42.

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Jaggar, Siân, and Helen Laycock. "Pain in the intensive cardiovascular care unit." In The ESC Textbook of Intensive and Acute Cardiovascular Care, edited by Marco Tubaro, Pascal Vranckx, Eric Bonnefoy-Cudraz, Susanna Price, and Christiaan Vrints, 956–68. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198849346.003.0072.

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Cardiac intensive care units admit a heterogeneous patient group Pain is common, occurring in up to 70% of medical and surgical patients Effective analgesia is important Pain is under-recognized and inadequately treated, particularly in medical patients Consequences of pain are widespread, involving multisystem physiological changes Pain causes significant psychological sequelae for patients, and ethical implications for physicians Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires: Understanding of the potential causes of pain in cardiac intensive care Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects Employing a multimodal, multidisciplinary management strategy

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Carter, R., Euan J. Dickson, and C. J. McKay. "Acute pancreatitis." In Oxford Textbook of Medicine, edited by Jack Satsangi, 3209–18. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0335.

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Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3-mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (more than three times the upper limit of normal) and/or lipase (more than twice the upper limit of normal). Several other acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. In equivocal cases, a CT scan is indicated to exclude other causes and confirm the diagnosis. Initial management is with (1) analgesia, (2) ensuring adequate oxygenation, and (3) intravenous fluid administration. The revision of the Atlanta classification separates patients clinically into (1) mild—with early resolution without complications, (2) moderate—local complications without organ failure, and (3) severe—complications associated with organ failure. Mild acute pancreatitis responds to analgesia and intravenous fluids. If gallstones have been identified, then cholecystectomy (or endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy where clinically appropriate) should be performed during the same admission, or at least within 2 to 4 weeks to prevent recurrent attacks. Severe acute pancreatitis carries a high mortality (up to 20%). Management in the early stages is centred on organ support (respiratory, circulatory, and renal failure). Later management involves surgical or radiological intervention for sepsis, usually within a specialist pancreatic unit.

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Waldmann, Carl, Andrew Rhodes, Neil Soni, and Jonathan Handy. "Pain and postoperative intensive care." In Oxford Desk Reference: Critical Care, 557–67. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198723561.003.0031.

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This chapter discusses pain and postoperative intensive care and includes discussion on pain management in the intensive care unit (ICU; including the causes and incidence of pain in the ICU, adverse effects of pain, assessment of pain in the ICU, and methods of pain relief in the ICU) and intensive care for the high-risk surgical patient (throughout the whole process). The chapter also covers the acute surgical abdomen in the ICU (and the complications thereof) and the medical patient with surgical problems (such as ischaemia of the bowel, acalculous cholecystitis, gallstone ileus, intra-abdominal hypertension, and soft-tissue infections).

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"Katelyn, a 4-Year-Old Girl with Fever and Neck Swelling." In Pediatric Hospital Medicine: A Case-Based Educational Guide, 291–304. American Academy of PediatricsItasca, IL, 2022. http://dx.doi.org/10.1542/9781610025935-case21.

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CASE PRESENTATION Katelyn is a 4-year-old girl with no significant medical history who was accepted for direct admission to the acute care unit from her pediatrician’s office, where she was seen for worsening fever and swelling on the right side of her neck. Her pediatrician has been treating her with amoxicillin-clavulanate for the past 3 days without improvement. The pediatrician requested admission for administration of intravenous (IV) antibiotics, imaging, and possible surgical consultation. You meet Katelyn and her family once they arrive to the acute care floor.

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Furmedge, Dan. "Geriatric Medicine." In Oxford Assess and Progress: Clinical Medicine. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198812968.003.0023.

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Geriatric medicine is the largest ‘medical’ specialty in the United Kingdom, with the number of geriatricians expanding at a huge rate with significant demand. Pragmatic specialists in frailty and complex co- morbidity, the work of geriatricians reaches across geriatric medicine wards, the acute medical unit, emergency departments and acute frailty units, surgical wards, and tertiary medical wards and in the community from inner city London to rural Scotland. They can be found in residential and nursing care homes, rehabilitation teams, and hospital at home teams. Frailty, falls, delirium, dementia, continence, immobility, rehabilitation, polypharmacy, nutrition, end- of- life care, advanced care planning, community medicine, and legal and ethical medicine are all core features of a geriatrician’s day. In this chapter, the questions give a taste of some of these concepts and will also demonstrate how geriatric medicine crosses almost every specialty.

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Hindocha, Sandip, and Kayvan Shokrollahi. "Desquamating skin disorders." In Burns (OSH Surgery), 331–38. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780199699537.003.0039.

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Exfoliating skin disorders or exfoliative and necrotizing disease of the skin form an important part for all those managing acute dermatological and plastic surgery emergencies; including the burns surgeon. It is imperative that such conditions are evaluated in a burns text as these patients should be managed on a burns unit with allied professional input. This chapter focuses on the classification, aetiology, and management of such disorders. Management includes initial assessment and suggested surgical approach. In addition scoring and prognostic indicators are referenced to allow the reader application of knowledge in clinical practice.

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Conference papers on the topic "Acute surgical unit"

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Pirjamali, Parisa, Harriet Crook, and Stephanie Hicks. "77 Improving end of life care in an acute surgical unit and trauma team – a quality improvement project." In Accepted Oral and Poster Abstract Submissions, The Palliative Care Congress 1 Specialty: 3 Settings – home, hospice, hospital 19–20 March 2020 | Telford International Centre. British Medical Journal Publishing Group, 2020. http://dx.doi.org/10.1136/spcare-2020-pcc.97.

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Nellessen, U., S. Jost, H. Hecker, S. Specht, V. Danciu, and P. R. Lichtlen. "FIVE-YEAR-FOLLOW-UP OF PATIENTS WITH UNSTABLE ANGINA: SURGICAL VERSUS MEDICAL TREATMENT." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643006.

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Among patients (pts) with coronary artery disease those with symptoms of an unstable angina pectoris form a subset particularly jeopardized with regard to threatening myocardial infarction (MI) or cardiac death (CD). We analyzed over 5.4±2.1 years (Y) the clinical course of 123 pts, who between 1977 and 1982 had to be admitted to the intensive care unit for reasons of persisting angina at rest. Within the first 24 hours no patient revealed a significant elevation of serum creatine kinase or typical alterations in the ECG due to acute MI (new Q-waves). During their stay in hospital (19±17 days) 43 pts (37 men, 6 women; age 58±7 Y) were subjected to bypass graft surgery, 80 pts (60 men, 20 women; age 58jh10 Y) were medically treated, 13 of whom underwent subsequent bypass graft surgery because of aggravation of symptoms. The table presents a survey of cardiac mortality and incidence of MI in the collectives with medical and surgical treatment during the stay in hospital and 1, 3 and 5 Y after dismissal (calculated according to the life-table method of Kaplan-Meier).Hence, during the initial hospitalization infarction and mortality rate in the medically treated group indeed were smaller than in the surgical collective; however, after dismissal this beneficial mortality rate turned into the opposite in the course of the following years. In this group nearly every MI was fatal.

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Barros, Thomas, Carolina Magalhães dos Santos, and Aline Marques. "Treatment of chronic wounds with 10% papain gel: a pilot study." In 7th International Congress on Scientific Knowledge. Biológicas & Saúde, 2021. http://dx.doi.org/10.25242/8868113820212416.

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Any interruption in the continuity of the skin, whether to a greater or lesser extent, is considered a wound and can be classified as acute or chronic. In Brazil and several parts of the world, the chronic wound is seen as a barrier to public health because, in addition to raising the cost for the health service, the patient is susceptible to numerous losses in quality of life, which can have social impacts, economic and psychological. For this reason, the investigation of alternative and low-cost technologies for the treatment of wounds is imperative. The study aimed to describe the use of 10% papain gel in the treatment of wounds arising from amputation processes, characterize the sociodemographic profile of individuals and trace the clinical profile of the patients involved in the study. For this, a pilot study was carried out in a Health Unit in the city of Campos dos Goytacazes/RJ, which works in welcoming patients with chronic wounds of different etiologies. The sample consisted of two individuals, of both sexes, with chronic wounds resulting from recent amputation processes in the lower limbs, treated with a 10% papain gel between April 19 and June 21, 2021. In clinical development, is considered the treatment of wounds with 10% papain gel and measurement of wound area using ImageJ software. Statistical analysis of data was performed using SPSS version 23 software. The sociodemographic results obtained showed that 100% of the sample was composed of patients of economically active age (±51.5 years), both living in areas far from the location where they undergo the treatment of the lesions (±28.5 km), requiring of great displacement to change dressings, which can hinder access to the Health Service. As for the characterization of the clinical profile, 100% of the sample had hypertension and diabetes undergoing treatment for both pathologies, with recent surgical amputation (less than 6 months) at the wound site. Regarding wound healing, patient A showed a reduction in wound area (cm2) of 37.54%, and patient B of 40.53%. Treatment with 10% papain gel was presented as a viable and low-cost alternative compared to the usual coverage offered by the public sector, representing an effective savings of 42% when comparing therapies with similar results. It is suggested that further studies be carried out to expand the scope of evaluation of the alternative therapy proposed by this study.

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RODRIGUES, Isabelle Medeiros, João Francisco Bianchini de TOLEDO, Thiago Abreu SAMAN, and Mário dos Santos FILHO. "UNILATERAL HYDRONEPHROSIS DUE TO URETER OBSTRUCTION AFTER OVARIO-HYSTERECTOMY IN A FELINE - CASE REPORT." In SOUTHERN BRAZILIAN JOURNAL OF CHEMISTRY 2021 INTERNATIONAL VIRTUAL CONFERENCE. DR. D. SCIENTIFIC CONSULTING, 2022. http://dx.doi.org/10.48141/sbjchem.21scon.34_abstract_rodrigues.pdf.

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Hydronephrosis is characterized by the renal pelvis and calyces distension resulting from total or partial urinary outflow obstruction. Ureter injuries are recognized complications of abdominal surgeries, especially sterilization, due to the frequency which they are performed in cats and dogs and the proximity between the ureter and the uterine stump. Some injuries may be acute or chronic, uni or bilaterally, affecting the urinary tract segment parts. Therefore, diagnosis is very important, especially early on, since it makes immediate management easier and may result in a better prognosis, especially when the disease course gets interrupted or its progression gets slowed. Furthermore, the importance of performing sporadic exams, even without previous clinical history for feline patients, is notorious since the nature of the species to hide clinical signs is well known. To certify the success of the surgery and integrity of the organs, it is very important to perform post sterilization exams. It is also crucial to state the importance of computed tomography for the diagnosis since some obstruction causes, such as blood clot, may not be shown in the ultrasound. Computed tomography is also necessary to differentiate hydronephrosis from many injuries that may affect the kidneys and ureters, like ectopic ureter, obstruction by calculi, and surgical ligature. The present study has the objective of reporting and discussing the laboratory, imaging findings, and clinical state of a patient with unilateral hydronephrosis, with asymptomatic evolution of iatrogenic origin due to obstruction by ureter obliteration after ovariohysterectomy (OVH).

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