ABSTRACT
Introduction: Abdominal haematomas are an uncommon complication of subcutaneous injection of low molecular weight heparin (LMWH) although the latter is widely administered. Aim(s): To review clinical cases of abdominal haematomas following subcutaneous LMWH injection, discover the root causes and identify appropriate solutions to improve clinical practice. Material(s) and Method(s): Retrospective case review of all clinical cases linked to abdominal haematomas secondary to LMWH injection. Result(s): Between 09.2020-01.2022, 760 patients were admitted in our Department due to COVID19 pneumonia. 4 cases of abdominal haematomas were reported (all females, mean age 70.5 years). All patients received therapeutic LMWH(3 for atrial fibrillation). All patients presented haematomas on rectus abdominis muscle and subsequently in the pelvic area. All patients presented with haemodynamic instability and required blood transfusions. Clinical outcomes included death (1), nephrostomy (1) (due to haematoma expansion and ureteral obstruction) and prolonged hospital stay by 12 days (2). Route cause analysis revealed improper injection technique in the following order;narrow abdominal margins, no skin folding, injection speed<10secs. Solutions were identified and followed including multidisciplinary nursing re-training that was implemented across the board and was accompanied by continuous monitoring of nursing practice. Conclusion(s): The rare complication of abdominal haematomas following LMWH was closely reviewed in our department and was turned into an opportunity to reconsider daily clinical practice, to contribute to quality improvement and improve patient safety.
ABSTRACT
Introduction: Covid-19 pneumonia presents with high morbidity and mortality and predictive biomarkers to guide treatment plans are lacking. Aim(s): To investigate the role of interleukin 6 (IL-6) on admission as a predictor for severe disease in patients admitted to a tertiary respiratory centre. Material(s) and Method(s): Retrospective study of patients admitted to our Department due to COVID19 pneumonia between 09.2021-12.2021. Medical records and local registry were thoroughly reviewed. Result(s): 149 patients were retrospectively reviewed with a mean age 64.5 years, (56% female, 44% male). IL-6 levels were not associated with the length of stay on the ward (p>0.5) or in the intensive care unit (p=0.5) or the patients' vaccination status. IL6<15 was associated with respiratory sufficiency and increased IL6 levels (>75) were associated with an increased risk for intubation and mechanical ventilation although not statistically significant. IL-6 levels on admission were not associated with pO2/FiO2 ratio or 28day mortality. Conclusion(s): In our cohort of patients IL-6 was not a predictive biomarker for clinical outcomes and therefore would not be a tangible tool to guide treatment plans.
ABSTRACT
Architecture has played a major part in designing hospitals with layouts for space to assist in patient recovery. Rooms oriented towards the light, with large windows and openings in wide balconies were designed to let patients be in the outdoors safely in the beginning of the last century in TB hospitals. The same balconies in our hospital, in 1924 and 2020. (see pictures) A century later, in 2020, our hospital "Sotiria Thoracic Diseases Hospital of Athens" was proclaimed the central hospital in the fight against the Covid-19 pandemic in Athens. We observed, how places that used to be sanatoriums operated during the Covid-19 era and compared the basic functions of the buildings. A major problem that appeared in the first months of the pandemic, was the shortage of protective equipment, which made everyday medical visits by the whole team of doctors difficult, time consuming, and expensive. Every day, the doctors except from visiting the rooms twice a day, visited their patients by accessing the balconies from the outside, wearing only a facemask. In conclusion, in the sudden appearance of the coronavirus in 2019, the wide balconies in our hospital proved their timeless usefulness in the fight against contagious respiratory diseases, giving patients the opportunity to see their doctors more, without spending resources of the hospital. Face to face communication, family visits and socialization, in the words of our patients, played a significant role in their psychological and overall wellbeing while being hospitalized.