Best Evidence on Acute Surgical Units and Management

This report evaluates primary and secondary research on acute surgical units and their management, focusing on topics like terminology, management of acute pancreatitis, fast track surgery, and early management techniques. The findings highlight the importance of effective patient care, pain management, and surgical resources. The report also discusses the challenges and advancements in acute surgical care.

WHAT IS THE BEST
AVAILABLE EVIDENCE
REGARDING THE USE
OF ACUTE SURGICAL
UNITS TO MANAGE
ACUTE SURGIC

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Terminology of Acute Surgical Units and its management........................................................1
Management of acute pancreatitis...............................................................................................2
Management of service users of fast track surgery.....................................................................3
Early management of acute pancreatitis.....................................................................................4
Pain management of Acute surgical............................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Acute surgery is the sense of emergency for patient as it can be life threatening
uncertainty. Every hospital across the globe have different unit and wards for patient of surgical
emergency because it is the most critical state for patient and surgeons. The report will evaluate
primary and secondary research of different authors on Acute Surgical Units and its
management, Management of acute pancreatitis etc. This analysis will assist in developing
critical understanding over the acute surgical units in hospital and their management. Thus, the
report will outline different conclusion made by the study and investigations of different authors.
MAIN BODY
Terminology of Acute Surgical Units and its management
According to (Acute care surgery: a new strategy for the general surgery patients left
behind, 2010), acute care surgery is requirement of urgent surgery which arise due to any
surgical emergencies. Sense of Surgical emergency first focuses on reason for admitting in
hospital. Thee acute surgical conditions are not limited and comprise, incarcerated hernias,
perforated viscous, pancreatitis, intestinal ischemia, etc. The most common practice which is
followed by hospital for acute surgery is presence of surgeon who is responsible for managing
almost all kind of surgeries for 12 to 24 hours. The acute surgery demands focus and
coordination among health practitioners which develops the sense of engagement with patient
care. According to research it has been derived that surgeons lacks personal life due to surgical
emergencies in hospitals. The approach of acute surgical care comprise, making predictions and
scheduling of surgeons, deriving the ability to focus on one issue, appropriate sue to surgical
tools and resources, improving patients access in order to make follow-up easy from surgical
emergency to discharge. The foremost priority of acute surgical units and management is to
ensure effective patients care under strict surveillance. On the other hand, (Fox and et.al., 2012),
management of surgical units involves management of surgical resources, staff and surgeons
specially at the time of night. Surgeons are placed in hospital as per their specialised
qualifications but in case of emergency every surgeons is responsible for taking change for
patients. These changes in practices are established only after proper training in order to maintain
safety of service users. Further, the management is responsible for maintaining appropriate
record and confidentiality of patient diagnosis and treatment. In addition, it is important to share
all the information about surgery to family and immediate guardians of surgical patients. It is the
1

secondary research which was conducted by different participants who have been into field of
surgery.
Management of acute pancreatitis
As per (Management of acute pancreatitis: from surgery to interventional intensive care,
2005), acute pancreatitis as been shifted from surgery to intensive care. The patient suffering
from mild pancreatic react easily to medicine but the individuals suffering from severe
pancreatitis can result in organ failure and many other complications. It develops in two phases,
first it is recognised by systemic inflammatory response syndrome. The development of this
syndrome may lead to organ failure or dysfunctions. In accordance to data collected in this
research acute pancreatitis has two primary objectives for treatment in which first the patient is
provided support therapy in which the practitioners faces major complications. The second
objective is to limit the causes of severity which can arise due to pancreatic redness.
However, as per (Venous thromboembolism risk and prophylaxis in the acute hospital
care setting (ENDORSE study): a multinational cross-sectional study, 2008), Venous
thromboembolism (VTE) is the common problem which arises with acute medical care and
surgery. It is the most common cause of deaths in hospital. Complication arising with this
syndrome leads to high cost investment and patient morbidity. In this research the scholar has
outlined the eligibility of hospitals for acute surgery in which the hospital are eligible when more
than 50 beds are occupied and treatment is related to severe chronic diseases. In this non acute
and specialist hospitals are not considered as part of acute surgery. In accordance to collected
data in this study more than half of patients in hospital are in risky stage against VTE. Thus, the
eligibility of hospital is also analysed by occupied beds and wards and its patients suffering from
acute disease such as cardiac and respiratory depression, paediatric, eye and throat surgery etc.
Nevertheless, (De Beaux, Palmer and Carter, 1995), has outlined primary study in which
279 patients were observed who were admitted to hospital for acute pancreatitis among them 210
were directly admitted in emergency and 69 were shifted to local and systemic complications.
There were patients who suffered from organ failure and there was urgent need of surgical
intervention. In accordance to 210 patients the death rate in hospital was 1.9% and for 69 patients
it was 18.8%. For acute surgery pancreatitis is the most common problems and lethal diseases.
Thus, the researcher has outlined that this disease ahas become so acute and common that not it
has been shifted from intensive care unit instead of acute surgery.
2

Management of service users of fast track surgery
According to (Wilmore and Kehlet, 2001), surgery in hospital are going with many
changes because it is considered among emergency department of hospitals. The surgeons are
coming with various new ways to manage acute surgery and pain control. The fast track
management of surgery is helping doctors in managing time stress and medication response to
minimize the risk of operations. Further, the researchers have outlined various surgical procedure
which comprise, sterilisation procedures, arthroscopic, cholecystectomy etc. The fast tract acute
surgery procedures of hospitals are focused on pain control, operative rehabilitation, managing of
nutrition and patient care services. Implementing fast track procedure for acute surgery assist the
surgeons in managing stress and dysfunctions of organs. Apart from this, in this study the
authors has collected information about recent advances which assist in acute surgery like, the
advanced techniques of providing anaesthesia helps the surgeons in improving outcomes of
medication and reducing surgical stress. Further, the method of surgical units during the day has
been changed in order to manage timing of hospital. Thus, the time of recovery has been
shortened to focus on pain control, managing nutrition, physical therapy of care etc.
However, (Dykes and et.al., 2010), has chosen cluster randomized investigation in which
fall rates of 4 Urban US hospitals have been interpreted. The research is focused on
implementation of fall prevention tool kit with health information technology that assist hospitals
3
Illustration 1: Factors contributing to surgical incidence
Sources: (Wilmore and Kehlet, 2001)

in integrating communication and flow of work which helps in delivering systematic patient care
services. With the help of this technique bed posters are allocated in patients room, handout of
patients education, care plans and communication with specialist. This helps in managing patient
care effectively and aids in minimizing risk. This research was conducted in 3 phases of study in
which the researcher focused on qualitative inquiry which helped in recognising restrictions
which can arise to fall risk communication. In second phase of research scholars aimed at
developing model by using risk factors. In this the decision of interview were included which
being analysed in phase 1. Thus, in phase three of investigation we involved the participation of
experts and who are icons for FPTK model. This helped in making areas of risk which can be
hindrance of patient safety in hospital and acute care wards.
Early management of acute pancreatitis
According to (Stigliano and et.al., 2017), managing acute pancreatitis is challenging
because it comes with major risk and side effects. In this study the researcher has focused on
collecting information from evidence which are already available. It is the evidence based study
where the keywords were Antibiotics, Acute Pancreatitis, pain management, endoscopic
treatment etc. The study defines that pain is Cardinal evidence which reflects acute redness.
Relieving acute pancreatitis is priority for health practitioners. The services users suffering from
severe pain are given intravenous analgesia. Apart from this, according to the pain of patients the
physicians are responsible for analysing ways for providing treatment which can reduce acute
redness. In this stud the researcher has outlined various clinical practices and its importance like
fluid resuscitation which is helpful for physicians in improving clinical practices. No mild acute
redness is related to increasing in fluid sequestration. The investigator analysed studies on fluid
infusion which concluded that rapid increase in fluid resuscitation can be harmful for human
body. Apart from this, from two Chinese studies it has been evaluated that crystalloids and
colloids in service user suffering from acute redness can lead to mechanical ventilation.
However, (Gaieski and et.al., 2010), has stated that combination of Early goal directed therapy
(EGDT) with hydrox-yethl starch (HES) and plasma can led to organ dysfunctional syndrome,
increase the time period of studying in intensive care unit and sometimes leads to ventilation.
Thus, from views of author it has been determined tat combination of three components in
human body can be life threatening.
4

In accordance to this (Gower and et.al., 2013), has stated that Anti biotic given by
practitioners to service users ensure that the treatments of acute redness is infection free.
Minimizing the chance of inflection when providing treatment is foremost practice conducted by
physicians. Further, from the research it has bee determine that most patients are treated with
intravenous antibiotics in order to treat infection rapidly. Apparently from the research it has
been identified that managing nutrition of patient suffering from Acute pancreatitis plays crucial
role in deriving solution to pain. The scholar analysed that discharge of service user from
hospital after suffering from acute redness is only done after analysing tolerance of oral re-
feeding. Oral re-feeding is related to intake of liquid and sold food. In this is the foremost
responsibility of doctors to analyse individuals tolerance to re-feeding after suffering from acute
redness. With intake of food the health care is responsible for managing three key duties of
patients feeding that is what to eat, when to eat and who will governing feeding habits of service
user. In this research the scholar ha analysed type of nutritional support one requires who has
been suffering from Acute pancreatitis. Parental nutrition and High quality of care which helps in
controlling risk which arise due to pancreatic infections. Apparently, in research it has been
identified that there are different routes of eternal feeding such as Nasogastric in which tube is
being inserted in presence of expertise such as radiologist and endoscopy. In addition, there is
duodenal feeding which is followed to increase pancreas secretion.
As per (Can, 2016.), Acute pancreatitis has become mos common issue which arise due
to increasing consumption of alcohol and gallstones. Therefore, from the research Framework of
clinical guidelines for managing acute pancreatitis has been identified which is formulated by
general surgery group by considering real life evidence of general surgery of acute pancreatitis.
In this every possible outcome of surgery has been included such as non infectious and infectious
length of surgery and stay in hospital, complication and patient morbidity. The framework
comprise steps such as diagnosis and assessment of severity of acute Pancreatitis. Then comes
supportive care in which patient safety and care services are being analysed. In fourth step of
framework nutrition of patient is being managed. In fifth step antibiotics are refereed to patient in
order to prevent infection. In sixth step the diseases is diagnosed and health is management in
order to keep a check over recovery. Lastly, the guidelines are focused on managing the patients
who have admitted under surgery and intensive care unit.
5

Pain management of Acute surgical
According to (Acute postoperative pain management, 2000), effective pain control
technique plays and crucial role for the surgical service user. Managing postoperative pain is
essential as it helps in reducing the chance of complication in cardiac and pulmonary. In this
research article scholar focused on primary research where the individuals has collected
information on Acute postoperative pain management from selected physicians. Further, in this
study researcher focused on pain management approaches, side effects of pain therapies. It
promotes earlier mobilisation and reduces the risk of vein thrombosis. The goals of pain
management is to ensure that patient pain does not go neglected because some pain and therapy
of acute surgery may lead to nausea, itchiness and sedation. The focus of practitioner is to
minimize pain and side effects of surgery and therapy. The side effects of postoperative pain can
be vomiting, depression, itchiness, respiratory depression, nausea etc. Among them respiratory
depression is the major side effects of acute surgery which can be life threatening if pain is being
neglected. According to research, there are 1 per 10000 service users who suffer from respiratory
depression due to ineffective pain management. In contrary, in order to manage pain, it is
important for the practitioners to understand pain history and symptoms. Pain symptom of every
patient are in appropriate and different from each other. However, (Clin, 2013), has stated that
monitoring pain has become critical issue as relieving patient at the time of surgery is important
because it can affect the health and treatment of service users. The management of pain at time
of surgery is concluded as quality measure because it helps in minimizing discomfort and side
effects of pain which can be risk for patients health. In this investigation the author implemented
the use of keyword to make research more effective. Keywords used are opoids, analgesia,
transversus abdominis etc.
CONCLUSION
The report summarized different articles and their investigation on the basis of Acute
Surgical Units which are the most crucial part of hospital and it management unit. Acute surgery
plays a most important and sensitive role in managing patient care therefore every authors and
research has it owns view point which analyse management of acute surgical units like from
Study Acute care surgery: a new strategy for the general surgery patients left behind it has been
outlined that surgical emergency can be of many types such as perforated viscous, pancreatitis
etc. and it is important for the management to ensure there are surgeons available for emergency
6

day and night. Further, from this investigation it has been concluded that priority of
management of surgical units is focused on effective patient care and safety. It can say that
managing acute surgery is crucial functions of hospital management because ineffective delivery
of services can be life threatening. Further, from the analysis it has been determined that Acute
Pancreatitis has become most common issue and therefore has been sifted from surgical
department to intensive care unit. Thus, the report concluded with studies of different authors
which comprises all the details regarding procedure pain and sense of emergency in cases of
acute surgery.
7

REFERENCES
Books and Journals
De Beaux, A.C., Palmer, K.R. and Carter, D.C., 1995. Factors influencing morbidity and
mortality in acute pancreatitis; an analysis of 279 cases. Gut. 37(1). pp.121-126.
Dykes, P.C. and et.al., 2010. Fall prevention in acute care hospitals: a randomized trial. Jama.
304(17). pp.1912-1918.
Fox, M.T. and et.al., 2012. Effectiveness of Acute Geriatric Unit Care Using Acute Care for
Elders Components: A Systematic Review and Meta‐Analysis. Journal of the American
Geriatrics Society. 60(12). pp.2237-2245.
Gaieski, D.F., and et.al., 2010. Impact of time to antibiotics on survival in patients with severe
sepsis or septic shock in whom early goal-directed therapy was initiated in the
emergency department. Critical care medicine. 38(4). pp.1045-1053.
Gower, E.W. and et.al., 2013. Perioperative antibiotics for prevention of acute endophthalmitis
after cataract surgery. Cochrane Database Syst Rev. 7.
Wilmore, D.W. and Kehlet, H., 2001. Management of patients in fast track surgery. Bmj.
322(7284). pp.473-476.
Online
Acute care surgery: a new strategy for the general surgery patients left behind. 2010. [Online].
Available through: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845958/>.
Acute postoperative pain management. 2000. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317048/>.
Can J. S. 2016. Clinical practice guideline: management of acute pancreatitis. [Online].
Available through: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814287/>.
Clin C. R. S., 2013 Postoperative Pain Control. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747287/>.
Management of acute pancreatitis: from surgery to interventional intensive care. 2005. [Online].
Available through: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774421/>.
8

Stigliano S. and et.al., 2017. Early management of acute pancreatitis: A review of the best
evidence. [Online]. Available through:
<http://www.dldjournalonline.com/article/S1590-8658(17)30196-2/pdf>.
Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE
study): a multinational cross-sectional study. 2008. [Online]. Available through:
<http://williams.medicine.wisc.edu/ENDORSE_study.pdf>.
9