The American journal of emergency medicine
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The outbreak of a novel coronavirus disease (COVID-19) has been of concern to health care workers (HCW's) in the emergency department (ED) due to potential exposure and transmission. This case report describes a man who was referred to the ED for abdominal and testicular pain who was subsequently found to test positive for COVID-19. Due to the lack of respiratory symptoms, proper protective equipment (PPE) was not donned, and it led to several patients and health care workers being exposed. Given recent new descriptions of patients who present atypically, full PPE for all patients may be considered as community spread increases.
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A 78-year-old patient with acute respiratory distress was transferred to our hospital with ST segment elevation on electrocardiography. Coronary angiography revealed normal coronary arteries. Thorax computerized tomography showed ground glass opacification with consolidation in the lungs and mild pericardial effusion demonstrating myopericarditis associated with COVID-19.
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Comparative Study
Presentation and outcomes of end stage liver disease patients presenting with septic shock to the emergency department.
Patients with end stage liver disease (ESLD) are particularly vulnerable to sepsis. ESLD patients are often excluded from controlled sepsis trials and more data are needed to guide the management of this population. ⋯ Patients with ESLD comprise a small but important subgroup of patients with ED septic shock that experience high mortality compared to patients without ESLD. Maximum ED lactate and pneumonia as the source of sepsis are independently associated with adverse outcome and may be used for early recognition of high-risk ESLD sepsis patients.
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Observational Study
Heart rate and heart rate variability in emergency medicine.
Tachycardia may be indicative of mental stress, which in turn can decrease performance, reduce information processing capacity, and hinder memory recall. The objective of this study is to examine heart rate trends present among emergency medicine trainees over a standard emergency room shift to measure the frequency and severity of stress experienced while on shift. ⋯ Continuous monitoring of HR in emergency medicine residents during standard critical care shifts using a wrist-worn device found marked elevations suggestive of episodic tachycardia.
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Observational Study
Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection.
To evaluate the added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection. ⋯ The inflammatory markers except C-reactive protein showed added predictive value to vital signs. Future studies should focus on developing and validating prediction models for use in individualized predictions including both vital signs and the significant markers.