The American journal of emergency medicine
-
Meta Analysis
Association of acute kidney injury with the severity and mortality of SARS-CoV-2 infection: A meta-analysis.
we aimed to explore the relationship of acute kidney injury (AKI) with the severity and mortality of coronavirus disease 2019 (COVID-19). ⋯ AKI is closely related with severity and mortality of COVID-19, which gives awareness for doctors to pay more attention for risk screening, early identification and timely treatment of AKI.
-
We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. ⋯ All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with "COVID-19 croup," SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.
-
Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis; however, final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. ⋯ Subsequent joint washout revealed purulent synovial fluid that grew out the same bacteria. This case emphasizes the importance of obtaining synovial fluid to evaluate for septic arthritis, even when joint effusion is absent. Ultrasound guidance can facilitate this.
-
Case Reports
A case of extrapleural hematoma that was not detectable on initial CT in a patient with pneumonia.
Extrapleural hematoma (EH) is an uncommon and occasionally life-threatening condition. Huge EH can cause potentially fatal respiratory and circulatory disturbances. The usual causes of EH are chest trauma, iatrogenic injury, and rupture of a thoracic aortic aneurysm. ⋯ The pathophysiology of the relationship between pneumonia and EH is unclear. This case suggests that EH cannot be ruled out by initial CT findings soon after an episode suggestive of hemorrhage and can occur as a complication of pneumonia. Therefore, patients in whom EH is suspected should be followed up closely.
-
Randomized Controlled Trial Multicenter Study
Absence of QT prolongation after administration of a 24-mg bimodal-release ondansetron pill (RHB-102).
Prospective data evaluating the effect of ondansetron on the corrected QT (QTc) interval is lacking in emergency department clinical use. As part of a randomized trial of a 24-mg bimodal-release ondansetron (RHB-102) pill, we tested the effect of RHB-102 compared to placebo on QTc change. ⋯ In patients with normal baseline QTc, 24-mg bimodal-release ondansetron did not prolong the QTc in comparison to placebo.