Fear of coronavirus and the need for quarantine should not deter people from seeking treatment for non-COVID acute medical and surgical emergencies. Over the last two weeks, we have come across several instances of patients and relatives seeking medical attention very late for even emergencies because of fear. Since all the clinics and many smaller hospitals are closed, we are seeing quite a high number of patients with cardiac, neuro, stroke, gastro, diabetic and orthopedic emergencies presenting late with all complications leading to delayed intervention and recovery.
What are the cardiac emergencies, which present late?
It is well known that cardiovascular death is the number one cause of death globally. The intervention in the golden hour after acute cardiac events like heart attacks will reverse the harmful effects and save lives. In the last few days, we have seen patients with acute coronary syndrome, heart rhythm abnormalities and complete heart block presenting late with all complications. Cardiac patients are also at increased risk of Covid-19 complications and they can present as heart attack, myocarditis and heart failure. All these patients need to be treated in hospitals with facilities for 24/7 Acute Coronary Care Units (ACCU), managed by senior cardiologists.
How about stroke and neuro emergencies?
Stroke is another medical emergency, which if treated within the window period of 4 hours will result in near-complete resolution of the condition. Now, we see many patients with stroke presenting late leading to complications, prolonged stay in ICU and delayed recovery. The delay in seeking treatment in these patients is due to several reasons like fear of Corona and lack of transport in the lockdown period.
But well equipped hospitals with facilities like Hyper Acute Stroke Unit (HASU) are manned round the clock by stroke physicians and nurses to take care even at this time of crisis. We also see patients with epilepsy with fits presenting late.
What are the gastrointestinal conditions one should take prompt treatment for?
We also see patients with acute abdominal conditions like appendicitis, cholecystitis due to gall stones and obstructed hernia presenting late with gangrene and perforation leading to peritonitis and sepsis. These patients needed emergency surgery and prolonged stay in ICU because of delays in seeking treatment. The complications could be avoided by early interventions.
What are the emergencies you see in diabetic patients now?
We see diabetic patients with very high blood sugar levels, presenting acutely with diabetic keto acidosis. Also, we see diabetic patients with cellulitis and sepsis presenting late. Diabetic patients have to be extra careful at this time, monitor glucose levels regularly and seek help early in case of abnormal levels.
How about injuries and fractures?
Though we see a sharp reduction in road traffic accidents, the number of people with fractures due to domestic fall have remained the same.
In particular, the elderly with hip fractures present to the hospital even a few days after the fracture with complications. They should be treated promptly.
The patients presenting with COVID-19-like symptoms are treated in isolation facilities so that the non-COVID emergencies are managed in the main hospital in an uninterrupted way. Please don’t ignore emergencies and call for help immediately.
Dr. Aravindan Selvaraj
Executive Director and Chief Orthopaedic Surgeon
Kauvery Hospital, Chennai