Cleveland Clinic journal of medicine
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Post-intensive care syndrome (PICS) describes new or worsening physical, cognitive, or mental impairments in a patient following critical illness or intensive care. The COVID-19 pandemic will likely result in many more patients with PICS and its associated health and economic challenges. Screening and assessment tools done during hospitalization, at discharge, and post discharge should be utilized to facilitate services and strategies to improve PICS outcomes for patient and their families.
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The typical findings of COVID-19 on chest radiography and computed tomography (CT) include bilateral, multifocal parenchymal opacities (ground-glass opacities with or without consolidation, and "crazy paving"). In most cases, the opacities are predominantly in the peripheral and lower lung zones, and several have rounded morphology. However, these imaging findings are not pathognomonic for COVID-19 pneumonia and can be seen in other viral and bacterial infections, as well as with noninfectious causes such as drug toxicity and connective tissue disease. Most radiology professional organizations and societies recommend against routine screening CT to diagnose or exclude COVID-19.
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Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19- associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients, with more aggressive prophylaxis and screening recommended for patients with D-dimer levels above 3.0 μg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.
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Acute, uncomplicated rhinosinusitis is a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease, or in surgical planning. The authors discuss key features of complicated and uncomplicated rhinosinusitis, management, and recommendations on the use of imaging in diagnosis.