ABSTRACT
OBJECTIVE: To estimate the waiting times of surgical emergencies and identify causes of delay. Study design. - Prospective study over 36 months. MATERIAL AND METHOD: From January 1996 to December 1998, surgical emergencies arriving to the Libreville Hospital Center have been classified in absolute emergencies (AE) and relative emergencies (RE). Five parameters have been measured: waiting before the first contact with the resident (T1); waiting time for making the decision of operation (T2); waiting time for the admission in the operating block (T3); waiting before the surgical intervention (T4); total duration of waiting between admission in the operating block and the beginning of the surgical intervention (TT). Concerning each one of those stages, the abnormal lengthening causes of time for surgical emergencies have been identified. RESULTS: During that period, 325 surgical emergencies have been received. The mean duration of surgical emergency management has been 504.3 +/- 613.7 min. Among those emergencies, 114 have been classified AE (35.1%) and 211 RE (64.9%) with mean durations of 421.2 +/- 347.0 min for AE and of 549.3 +/- 722.5 min for RE. Some delays in the management of emergencies have been found among 176 patients (54.2%). Their frequency has been 58.8% for AE and 51.7% for RE. The most current cause of delays has been the waiting of complementary medical tests results (44.4%), followed by difficulties in supplying (31.1%) and by technical or staff problems (24.1%). CONCLUSION: This study has permitted to show that the waiting times of surgical emergencies management are abnormally long in Libreville hospital center. There is an important frequency in delays as well for RE as for AE. Socio-economic problems are very important. It seems necessary to organize surgical emergencies management in a specific structure and codify the prescription of complementary medical tests.
Subject(s)
Emergency Medical Services , Surgical Procedures, Operative , Adolescent , Adult , Aged , Appointments and Schedules , Child , Child, Preschool , Female , Gabon , Humans , Male , Middle Aged , Pregnancy , Prospective Studies , Time FactorsABSTRACT
In tropical zones, snakebites are considered serious. Exotic snakes are characterised by the poisonousness of their venom and its abundance. Death is rapid in some cases and in others the sequelae are serious. Worldwide, there are more than 5 million victims per year, with 50,000 deaths registered and 400,000 amputations. The frequency and severity of snakebites in Gabon remain unknown. It is estimated that there is an average of one snakebite every 4 days, thus some 91 snakebites per year. Through a study carried out at the Libreville Hospital, we evaluated the frequency, severity, and fatality of this circumstantial pathology. A retrospective study conducted on 157 patients admitted for snakebite at the Intensive Care Unit of the Libreville Hospital was carried out between 1998 and 2001. 1.32% of all admissions were for snakebites. Signs of venom poisoning were observed in 27 patients (17%), versus 130 cases without envenomation. The majority of cases were in adults (78%) and children affected (22%) were aged mainly 6-14 years. The snakebite season usually coincided with the rainy season. During this period, 19 cases were registered. Snakebites occurred during the daytime (93%), in the fields in 20 cases (75%) or in the home courtyard (25%). The victims lived in town in 25 cases (93%). Antivenom was used in all envenomation cases, and the result was favourable in 23 cases (18%) but unfavourable in 4 (15%).
