829 Perioperative Surgical Patients and The Availability and Utilisation Of ECGs Machines Pre- And Post-Pandemic

Introduction

ECGs are a NICE recommended pre-operative investigation and an integral part of post-operative monitoring. Delay in recognition of cardiac pathology can be catastrophic. Therefore, ECG machines should be readily available. Here, we report the results of an audit assessing the availability of ECG machines in surgical wards.

Method

In 2018 and then 2020, a bespoke, nine-item audit proforma was disseminated to all foundation doctors.

Results

In 2018, 17/32 wards had a ward based, readily available machine, 6/32 shared with another ward and 15/32 did not have a ward-based machine. The same was noted in 2020. In 2018 and 2020, the average time to obtain an ECG machine was 27 and 23 respectively. When no ECG was available, a doctor would obtain the machine 24% in 2018 compare to 52% in 2020. The diagnoses of the patients who had ECGs in 2018 were: normal sinus rhythm, atrial fibrillation, bradycardia, supraventricular tachycardia, sinus tachycardia and STEMI. In 2020 were: normal sinus rhythm, atrial fibrillation, supraventricular tachycardia, sinus tachycardia, atrial flutter, bradycardia, prolonged QTc, hyperkalaemia, STEMI and NSTEMI. The average time for NSTEMI patients to have an ECG was 35mins while for STEMI patients was 11.6mins.

Conclusions

Whilst our audit has highlighted the importance of ECG machine availability, the time to obtain one remained static between the two cycles. A study investigating the impact on patient outcomes may highlight the necessity for available ECG machines further.

911 Delayed Presentation of a Re-Bleed from A Traumatic Splenic Artery Rupture Following Endovascular Management in A Patient with Median Arcuate Ligament Syndrome

Endovascular management of splenic blunt trauma is widely accepted as a safe and effective alternative to open surgery in carefully selected patients. Following a radiologically successful intervention, patients are normally discharged with no follow up after 48-72 hours of haemodynamic stability and satisfactory serial haemoglobin levels.

We present a case of a fit and well 24-year-old male patient who presented with abdominal pain, syncope and haemodynamic instability 14 days post successful splenic artery coil-embolization for splenic artery aneurysm rupture secondary to blunt trauma. After initial resuscitation, computed tomography angiography was performed and demonstrated active bleeding from the splenic artery aneurysm which was deemed likely to be a consequence of retrograde filling. The patient underwent successful emergency re-embolization using a combination of embolization coils and Onyx via a trans-splenic approach to eliminate retrograde flow. On further review of the imaging, it was incidentally noted there was evidence suggesting a diagnosis of median arcuate ligament syndrome, which may have predisposed the patient to splanchnic artery aneurysm formation.

This case report highlights a potential limitation of endovascular management compared to open surgery and summarises the literature surrounding splenic artery anatomical variations and the implications of median arcuate ligament syndrome. A re-bleed following embolization is a hostile prospect with potentially catastrophic outcomes for patients if not recognised quickly. The authors propose that interval re-imaging should be considered following endovascular management of blunt splenic trauma.

Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation

OBJECTIVE

To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice.

DESIGN

Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatment.

SETTING

South east England.

SUBJECTS

56 patients with a history of atrial fibrillation.

INTERVENTIONS

Assessment and interview to ascertain patients' views on antithrombotic treatment.

MAIN OUTCOME MEASURES

Number of patients receiving antithrombotic treatment.

RESULTS

Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients were taking warfarin. Of the remaining 48 patients (of whom 41 were taking aspirin), eight were too ill to participate, 16 were unable to consent, four refused the interview, and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as measured by the minimal clinically important difference. Qualitative data obtained during the interviews suggested that patients' health beliefs were important factors in determining their choice of treatment.

CONCLUSION

Patients' unwillingness to take warfarin seemed to be a major factor in limiting the number who would eventually take it.