The American journal of emergency medicine
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During the recent CoVID-19 pandemic, airway management recommendations have been provided to decrease aerosolization and risk of viral spread to healthcare providers. High efficiency particulate air (HEPA) viral filters and adaptors are one way to decrease the risk of aerosolization during intubation. When placed proximal to the ventilator circuit, these viral filters and adaptors can create a significant amount of dead space, which in our smallest patients can significantly impact effective ventilation. We report a case of hypoventilation in a pediatric patient due to lack of provider team appreciation or ventilator sensing of additional dead space due to HEPA viral filter and adaptor.
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Multicenter Study
Antibiotic prescribing for adult bacteriuria and pyuria in community hospital emergency departments.
To describe emergency department (ED) antibiotic prescribing for urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) and to identify improvement opportunities. ⋯ Among reviewed patients, poor UTI prescribing in 16 EDs resulted in unnecessary antibiotic days and preventable readmissions. Key areas for improvement include non-treatment of ASB and shorter durations for cystitis.
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Coronavirus disease 2019 (COVID-19) is primarily a febrile respiratory illness that was first documented in China in December 2019 and shortly after declared a pandemic on March 11, 2020. The pathophysiology of the virus is still not completely understood and remains under investigation. Consequently, new symptomatic manifestations and complications of the disease continue to be discovered. Here we present the case of a spontaneous hemopneumothorax resulting in hemorrhagic shock in an adult male with PCR confirmed COVID-19.
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Coronavirus 2019 (COVID-19) is a viral disease first described in Wuhan, China, which has quickly emerged as a global pandemic with a myriad of manifestations including dermatologic (Li My et al., n.d.; Gottlieb and Long, 2020 [1,2]). A variety of cutaneous symptoms have presented throughout various stages of the disease (Marzano, 2020; Recalcati, n.d.; Henry et al., n.d.; Fernandez-Nieto et al., n.d.; Quintana-Castanedo et al., n.d. [3-5,7,8]). ⋯ The patient described tested positive for COVID-19 three days prior to presentation for the rash with minimal other symptoms of COVID-19. Given the high infectivity rate as well as multisystem presentation, it is important to continue to report on novel presentations of the virus for early identification and treatment of complications.
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Multicenter Study
Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging.
Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE). ⋯ Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system.