Journal of the American College of Emergency Physicians open
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Historically, the prone position was used almost exclusively in the ICU for patients suffering from refractory hypoxemia due to acute respiratory distress syndrome (ARDS). Amidst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, however, this technique has been increasingly utilized in settings outside of the ICU, particularly in the emergency department. With emerging evidence that patients diagnosed with COVID-19 who are not intubated and mechanically ventilated may benefit from the prone position, this strategy should not be isolated to only those with critical illness. ⋯ Given present concerns about resource limitations because of the pandemic, prone positioning has especially demonstrable value as a technique to delay or even prevent intubation. Patients who are able to self-prone should be directed into the ''swimmer's position'' and then placed in reverse Trendelenburg position if further oxygenation is needed. If a mechanically ventilated patient is to be placed in the prone position, specific precautions should be taken to ensure the patient's safety and to prevent any unwanted sequelae of prone positioning.
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J Am Coll Emerg Physicians Open · Jun 2020
Lessons learned from COVID-19 outbreak in a skilled nursing facility, Washington State.
Long-term care facilities have been identified as a local epicenter of disease among populations vulnerable to coronavirus disease 2019 (COVID-19). A skilled nursing facility in Washington State was the first major site of COVID-19 infections in the United States. Many lessons were learned during the events surrounding this outbreak, including how to develop, and the importance of, a coordinated response between emergency medical services and local area hospitals. ⋯ S. pandemic, unfortunately, disease spread and mortality was high. However, these events also resulted in rapid mobilization of the regional response to the COVID-19 pandemic. Understanding the events surrounding this outbreak demonstrate some of the challenges involved in responding to acute infectious illnesses within these unique environments and associated vulnerable populations.
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J Am Coll Emerg Physicians Open · Jun 2020
Clinical, laboratory, and radiological features indicative of novel coronavirus disease (COVID-19) in emergency departments - a multicentre case-control study in Hong Kong.
Little is known about the value of routine clinical assessment in identifying patients with coronavirus disease 2019 (COVID-19) in the emergency department (ED). We aimed to compare the exposure history, signs and symptoms, laboratory, and radiographic features of ED patients who tested positive and negative for COVID-19. ⋯ This study highlights a number of clinical features that may be useful in identifying high-risk patients for early testing and isolation while waiting for the test result. Further studies are warranted to verify the findings.This article is protected by copyright. All rights reserved.
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J Am Coll Emerg Physicians Open · Jun 2020
Viral and atypical respiratory co-infections in COVID-19: a systematic review and meta-analysis.
Respiratory co-infections have the potential to affect the diagnosis and treatment of COVID-19 patients. This meta-analysis was performed to analyze the prevalence of respiratory pathogens (viruses and atypical bacteria) in COVID-19 patients. ⋯ Co-infection with respiratory pathogens is a common and potentially important occurrence in patients with COVID-19. Knowledge of the prevalence and type of co-infections may have diagnostic and management implications.
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J Am Coll Emerg Physicians Open · Jun 2020
ReviewManaging sedation in the mechanically ventilated emergency department patient: a clinical review.
Managing sedation in the ventilated emergency department (ED) patient is increasingly important as critical care unit admissions from EDs increase and hospital crowding results in intubated patients boarding for longer periods. The objectives of this review are 3-fold; (1) describe the historical perspective of how sedation of the ventilated patient has changed, (2) summarize the most commonly used sedation and analgesic agents, and (3) provide a practical approach to sedation and analgesia in mechanically ventilated ED patients. ⋯ Our review of the literature found that the level of sedation and practices of sedation and analgesia in the ED environment have downstream consequences on patient care including overall patient centered outcomes even after the patient has left the ED. It is reasonable to begin with analgesia in isolation, although sedating medications should be used when patients remain uncomfortable and agitated after initial interventions are performed.