The American journal of emergency medicine
-
Prolongation of the QTc interval is associated with an increased risk of malignant ventricular dysrhythmias, such as ventricular tachycardia (VT), and sudden cardiac death. The quantifiable risk rates of adverse dysrhythmic outcome in relation to specific QTc interval length are not known. We conducted a literature review on the topic of QT interval prolongation in adult patients and the associated risk of malignant dysrhythmic event. ⋯ From this literature, we were unable to answer the question in a quantifiable manner and only noted that the risk of malignant dysrhythmic event increases with progressively longer QTc interval. The current literature on this topic is inadequate to answer this important question due to heterogenous study methodology, patient populations, endpoints, and periods of observation. Additional prospective research is required on this topic, aimed at addressing the important issue of specific, quantifiable risk and its relation to degree of prolongation of the QTc interval.
-
Observational Study
Keep your distance! Measuring staff physical distancing during the Sars-Cov-2 pandemic using a real-time locating system.
Staff-to-staff transmission of SARS-CoV-2 poses a significant risk to the Emergency Department (ED) workforce. We measured close (<6 ft), prolonged (>10 min) staff interactions in a busy pediatric Emergency Department in common work areas over time as the pandemic unfolded, measuring the effectiveness of interventions meant to discourage such close contact. ⋯ This study included a total of 12,386 pairs of staff-to-staff encounters over three time periods including just prior to the pandemic, early in the pandemic response, and later in the steady-state pandemic response. Pairs of staff averaged 0.89 high-risk interactions hourly prior to the pandemic, and this continued early in the pandemic with informal recommendations (0.80 high-risk pairs hourly). High-risk staff encounters fell significantly to 0.47 interactions per hour in the steady-state pandemic with formal distancing guidelines in place and decreased patient and staffing volumes. The duration of these encounters remained stable, near 16 min. Close contact between healthcare staff workers did significantly decrease with formal distancing guidelines, though some high-risk interactions remained, warranting additive protective measures such as universal masking.
-
Observational Study
Pediatric point-of-care ultrasound of optic disc elevation for increased intracranial pressure: A pilot study.
Papilledema is often difficult to detect in children. Ocular point-of-care ultrasound (POCUS) measurement of the optic nerve sheath diameter (ONSD) is a non-invasive test for increased intracranial pressure (ICP), but no consensus exists on normal pediatric ONSD values. Detection of optic disc elevation (ODE, a component of papilledema) using POCUS has recently been qualitatively described. We sought to establish the diagnostic accuracy of different ODE cutoffs to detect increased ICP in children who underwent ocular POCUS in our pediatric emergency department (PED). ⋯ ODE-B may represent the optimal ocular POCUS measurement for detecting increased ICP in children, and future prospective studies could more accurately describe the diagnostic performance of different pediatric ODE-B cutoffs.
-
Case Reports
Triple threat: New presentation with diabetic ketoacidosis, COVID-19, and cardiac arrhythmias.
Patients with diabetes have increased susceptibility to infection with Severe acute respiratory syndrome-coronavirus 2 and increased morbidity and mortality from Coronavirus disease 2019 (COVID-19) infection. Mortality from COVID-19 is sometimes caused by cardiac arrhythmias. ⋯ In this case report we describe two children with COVID-19, new-onset DKA and cardiac arrhythmias. These cases emphasize the importance of close cardiac and electrolyte monitoring in patients with COVID-19 infection.
-
Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims. ⋯ While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.