The American journal of emergency medicine
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As shown by the current COVID-19 pandemic, emergency departments (ED) are the front line for hospital-and-community-based care during viral respiratory disease outbreaks. As such, EDs must be able to reorganize and reformat operations to meet the changing needs and staggering patient volume. This paper addresses ways to adapt departmental operations to better manage in times of elevated disease burden, specifically identifying areas of intervention to help limit crowding and spread. ⋯ Triage should identify and geographically cohort symptomatic patients within a designated unit to limit exposure early in an outbreak. Screening and PPE guidelines for both patient and staff should be followed closely, as determined by hospital administration and the CDC. Equipment needs are also greatly affected in an outbreak; we emphasis portable radiographic equipment to limit transport, and an upstocking of certain medications, respiratory supplies, and PPE.
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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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Case Reports
Diagnosis of neurofibromatosis type 1 after rupture of aneurysm and consequent fatal hemothorax.
Patients with neurofibromatosis type 1 (NF1) can develop both benign and malignant tumors throughout their lives. A 49-year-old man was transferred to the emergency department with complaints of sudden right dorsal pain and respiratory discomfort. He was in shock on arrival. ⋯ As his deceased mother was an NF1 patient, we diagnosed him with NF1. Detailed patient history and early-stage examination led to the early diagnosis. NF1 should be considered as an early differential diagnosis to improve the outcome of patients in such cases.
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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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Case Reports
Inhaler intoxications developed during autopsy of the corpse due to cyanide intake: Case series.
The primary cause of cyanide intake is suicidal attempts, most of which result in death. People who interfere with suspicion of cyanide intoxication may also be exposed to cyanide poisoning. ⋯ Meanwhile, a 36-year-old patient who had come into contact with the patient at night also presented to the ED. Some of the precautionary measures to be taken against inhalation of cyanide may be wearing appropriate masks as well as suitable clothes and keeping the surroundings below 28 °C when exposed to cyanide.