The American journal of emergency medicine
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It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT. ⋯ The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.
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Characterizing respiratory syncytial virus (RSV) infections before and during the COVID-19 pandemic.
Following the onset of the COVID-19 pandemic, RSV infections deviated from a previously reliable epidemiologic pattern of presentation. To investigate whether this change in RSV seasonality resulted in a change in frequency and severity of RSV infections, this single center retrospective study compares demographic and hospital factors during RSV seasons before and after the onset of the COVID-19 pandemic. ⋯ During the first three RSV seasons after the onset of the COVID-19 pandemic, our pediatric emergency departments saw more RSV positive patients than in the last three seasons beforehand. These patients were significantly older and less likely to be admitted, which may be partly due to increased respiratory viral testing during the pandemic. However, shorter LOS and decreased intubations despite increased respiratory support among admitted patients may indicate a paradigm shift in emergency department and inpatient management of severe RSV infections, perhaps encouraged by practice changes and resource limitations due to COVID-19. This information may better guide institutions in predicting resource needs after large-scale infectious disease outbreaks in the future.
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While angioembolization is occasionally required for craniofacial fracture patients who experience massive maxillofacial hemorrhage, complications such as headache, temporal-facial pain, soft tissue necrosis, and embolic material migration leading to stroke or blindness can arise. Few studies have explored delayed or progressive intracerebral hemorrhage (ICH) following angioembolization for craniofacial fractures. ⋯ A greater probability of delayed or progressive ICH was observed in craniofacial fracture patients who underwent angioembolization for maxillofacial hemostasis.
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Abdominal pain remains a top chief complaint for patients presenting to the emergency department (ED). Benign or emergent etiologies can present similarly. A thorough history and physical examination are critical for emergency physicians, especially for post-operative patients with concerns for a possible bowel perforation. Hysteroscopies with myomectomies are a minimally invasive surgical technique to remove fibroids. Gynecologic procedures historically have a low incidence of bowel perforation, however, in patients with post-operative pain presenting to the ED, distinguishing between a normal post-operative course and a post-operative complication can be challenging. ⋯ This patient initially presented with abdominal pain associated with nausea and vomiting following a hysteroscopy with myomectomy, where initial testing led to a possible diagnosis of enteritis. Due to her continued abdominal pain, the ED physician admitted the patient, and it was found that she had two ileum perforations from suspected uterine perforations.
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Post-cardiac arrest care advancements have improved resuscitation outcomes, but many survivors still face severe neurological deficits or death from brain injury. Herein, we propose a consistent prognosis prediction approach using magnetic resonance imaging (MRI) to analyze anatomical regions represented by the gray and white matter, and subsequently apply it on computed tomography (CT) to calculate the gray-white matter ratio (GWR). We compared this novel method with traditional measures to validate its ability to predict the prognosis of patients resuscitated after cardiac arrest. ⋯ Our study introduces a novel method for measuring GWR using MRI-based brain CT, demonstrating superior prognostic accuracy in predicting neurological outcomes in patients with post-cardiac arrest syndrome compared to traditional methods.