Is acute pancreatitis to be feared?
I have previously expressed my opinions about the management of acute pancreatitis. Managing acute pancreatitis is a complex affair, with many decisions to be made in a single day. It is easy for treatments to go wrong at any time frame. In fact, our audit of 2 hopsitals revealed exactly the same.
From the patients point of view, death and severe morbidity looms large as they lie under numerous tubes and catheters and nurses and doctors hovering around. Over the 13 years, I have been managing these patients, I have lost some of the fear of this disease and that is probably because of my personal experience. Though many disagree with me, I feel there is ample opportunity to correct the factors that determine outcome in pancreatitis and it is only when every window of opportunity is missed, things take an ugly turn. So for every patient, I assure them, the disease is treatable and every attempt made and support given till good recovery. I have not been proved wrong till now. I am open to the challenge.
The key lies in executing all the process of care effectively. This is a major shortfall in the management. Inadequacies abound in the manangement. I have seen patients present late to the hospital and this, apart from prevention lies in the patient's own hands. As a doctor, I have little say on this. But the clock of treatment starts as soon as the diagnosis is established in the hospital.
In practice, we follow 6 time frames in management. Two 6 hour protocols, one 12 hour protocol and three 24 hour protocols are all what we use routinely. This is a little unconventional - but one which stands on the foundations of current available evidence. We establish diagnosis, assess severity of the disease, look for predictors of severe disease and adequately resuscitate the patient in the first 6 hours. In the second 6 hours, we assess how the patient is improving using clinical and laboratory criteria, check whether the organ failure is better. the next 12 hours is utilised only for resuscitation. This completes 24 hours of inpatient management. Our patients improve significantly within this time frame.
Our challenge is to get all this done within the first 96 hours. Currently, we are able to do this in approximately 70 % of the patients.
To improve the efficay of the treatment, we have introduced a checklist. All the elements that we use to diagnose, assess and treat acute pancreatitis is listed here. We have simplified it enough for any doctor in our hospital to follow the protocol. In 50 check points, we have completed the 4 day treatment protocol so that the patient recieves all the necessary support required for good recovery.
We have eliminated the delay in the initiation of treatment, by providing guidelines to the staff of the GI surgery and General surgery department. They initiate the treatment under the guidelines provided and we have consistently seen the improvement in our patients within the first 2 days.
Fear seems distant. Especially the fear of death.
From the patients point of view, death and severe morbidity looms large as they lie under numerous tubes and catheters and nurses and doctors hovering around. Over the 13 years, I have been managing these patients, I have lost some of the fear of this disease and that is probably because of my personal experience. Though many disagree with me, I feel there is ample opportunity to correct the factors that determine outcome in pancreatitis and it is only when every window of opportunity is missed, things take an ugly turn. So for every patient, I assure them, the disease is treatable and every attempt made and support given till good recovery. I have not been proved wrong till now. I am open to the challenge.
The key lies in executing all the process of care effectively. This is a major shortfall in the management. Inadequacies abound in the manangement. I have seen patients present late to the hospital and this, apart from prevention lies in the patient's own hands. As a doctor, I have little say on this. But the clock of treatment starts as soon as the diagnosis is established in the hospital.
In practice, we follow 6 time frames in management. Two 6 hour protocols, one 12 hour protocol and three 24 hour protocols are all what we use routinely. This is a little unconventional - but one which stands on the foundations of current available evidence. We establish diagnosis, assess severity of the disease, look for predictors of severe disease and adequately resuscitate the patient in the first 6 hours. In the second 6 hours, we assess how the patient is improving using clinical and laboratory criteria, check whether the organ failure is better. the next 12 hours is utilised only for resuscitation. This completes 24 hours of inpatient management. Our patients improve significantly within this time frame.
Our challenge is to get all this done within the first 96 hours. Currently, we are able to do this in approximately 70 % of the patients.
To improve the efficay of the treatment, we have introduced a checklist. All the elements that we use to diagnose, assess and treat acute pancreatitis is listed here. We have simplified it enough for any doctor in our hospital to follow the protocol. In 50 check points, we have completed the 4 day treatment protocol so that the patient recieves all the necessary support required for good recovery.
We have eliminated the delay in the initiation of treatment, by providing guidelines to the staff of the GI surgery and General surgery department. They initiate the treatment under the guidelines provided and we have consistently seen the improvement in our patients within the first 2 days.
Fear seems distant. Especially the fear of death.
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