The American journal of emergency medicine
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Observational Study
Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index.
The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients. ⋯ In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration.
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COVID-19 spread worldwide, causing severe morbidity and mortality and this process still continues. The aim of this study to investigate the prognostic value of right ventricular (RV) strain in patients with COVID-19. ⋯ Presence of right ventricular strain pattern on ECG is associated with in hospital mortality in patients with COVID-19.
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Prosthetic valve thrombosis (PVT) is considered an exceptionally rare condition, often associated with pro-thrombotic factors or suboptimal anticoagulant therapy. Guidelines recommend emergent surgery for patients with left heart valve prosthetic thrombosis who present in cardiogenic shock, and systemic thrombolysis is reserved in scenarios where surgery is not immediately available. However, several factors may affect surgical prognosis and are overlooked by current recommendations. We describe the case of a 34-year-old female who presented in the emergency department with cardiogenic shock and acute pulmonary edema due to acute valve thrombosis.
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Spontaneous pneumothorax (SP) is characterized by the escape of broncho-alveolar air into presence of air in the pleural space without preceding blunt or penetrating trauma. SP requires prompt diagnosis and treatment. SP is divided into two groups as primary and secondary. ⋯ However, late-onset SP after recovering from COVID-19 is unusual. Herein we present a case with post-COVID-19 pulmonary fibrosis-like changes and subsequent late onset spontaneous pneumothorax (SP). We also present the patient's radiological findings.
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Awake intubations in the emergency department: A report from the National Emergency Airway Registry.
To describe awake intubation practices in the emergency department (ED) and report success, complications, devices used, and rescue techniques using multicenter surveillance. ⋯ Awake intubation in this multicenter cohort of emergency department patients was rare and was performed most often in patients with airway edema or obstruction. Emergency physicians performed the majority of first intubation attempts with high first-attempt success. Further studies are needed to determine optimal emergency airway management in this patient population.