1508 Acute ENT Clinic Audit

Introduction

The acute ENT clinic is run by the ENT SHO’s and is used to assess and treat patients with a variety of everyday ENT pathology. As a department, we are seeing increasing numbers of patients who have been referred via the community for conditions that do not meet the departmental guidelines as well as noting our clinic is consistently overbooked and overrunning.

Method

A retrospective audit was performed analysing all clinic data between December 2019 and January 2020, specifically looking at patient demographics and reason for referral. The total number of patients per clinic was analysed and compared against ENT UK guidelines for safe clinic numbers, which state that an SHO led acute clinic should have 6 patients maximum.

Results

Over a two-month period, we looked at data from 35 clinics. As per our standard operating practice, children should be seen first in the clinic and this occurred in only 8 clinics (22.9%). Secondly, 8 clinics had appropriately booked a maximum of 6 patients, whilst in 27 clinics (77.2%) there were more than 7 patients booked. Finally, 69.8% of patients had unsuitable referrals as per the guideline.

Conclusions

It is clear from our data that the capacity of the acute clinic does not meet its current demand, and this is something that needs to be addressed to ensure patient safety and to adhere to ENT UK guidance. The implementation of a more stringent referral system will increase patient safety by ensuring patients with appropriate pathology are seen in this clinic.

947 Mycotic Pseudoaneurysm Of the Common Carotid Artery: A Rare Neck Lump

Mycotic pseudoaneurysms are rare, potentially fatal arterial wall infections of either fungal or bacterial origin. The estimated incidence is 20 cases/decade. Trauma is the commonest cause and in 25% the cause remains unknown.

A 62-year-old man presented with a three-week history of a non-tender enlarging neck lump associated with hoarseness of voice. He was apyrexial with no stridor nor dysphagia. The lump measured 10x10cm at levels II-III on the left side of the neck with no overlying erythema. After normal oral examination, flexible nasendoscopy revealed a left-sided pharyngeal swelling occluding 25% of the airway. He was commenced on intravenous antibiotics and steroids. A contrast enhanced CT demonstrated a mycotic pseudoaneurysm of the left common carotid artery (CCA) with a linear foreign body exiting the oesophagus. He underwent emergency surgery with the vascular team to excise 3cm of unhealthy CCA with long saphenous vein graft repair. Neck exploration and panendoscopy found no further defects including no foreign body. He made an excellent recovery and is awaiting an injection thyroplasty to manage his complete left vocal cord palsy.

Although rare, vascular injury and subsequent pseudoaneurysm is an important differential and should always be considered in those presenting with neck swelling.

Silicon drift detector based X-ray spectroscopy diagnostic system for the study of non-thermal electrons at Aditya tokamak

Silicon drift detector based X-ray spectrometer diagnostic was developed to study the non-thermal electron for Aditya tokamak plasma. The diagnostic was mounted on a radial mid plane port at the Aditya. The objective of diagnostic includes the estimation of the non-thermal electron temperature for the ohmically heated plasma. Bi-Maxwellian plasma model was adopted for the temperature estimation. Along with that the study of high Z impurity line radiation from the ECR pre-ionization experiments was also aimed. The performance and first experimental results from the new X-ray spectrometer system are presented.