J Emerg Med
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Observational Study
Lung Ultrasound vs. Chest X-Ray Study for the Radiographic Diagnosis of COVID-19 Pneumonia in a High-Prevalence Population.
The viral illness severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more commonly known as Coronavirus 2019 (COVID-19), has become a global pandemic, infecting over 100 million individuals worldwide. ⋯ LUS was more sensitive than CXR at radiographically identifying COVID-19 pneumonia.
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Prolonged emergency department (ED) wait times could potentially lead to increased morbidity and mortality. While previous work has demonstrated disparities in wait times associated with race, information about the relationship between experiencing homelessness and ED wait times is lacking. ⋯ Undomiciled patients experience longer ED wait times when compared with domiciled patients. This disparity is not explained by undomiciled patients seeking care in the ED for minor illness, because the disparity is more pronounced for urgent and emergent triage categories.
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The global burden of seizure disorders is apparent and necessitates the effective management of patients with status epilepticus (SE). The goal of management is universally accepted as the prompt mitigation of seizure activity with appropriate supportive care. During management, patients may require intubation. In the process of endotracheal tube placement, patients are administered neuromuscular blockers and general anesthesia. Paralytic activity on the neuromuscular junction hinders the emergency physician's ability to effectively observe seizure activity. Moreover, little can be discerned about patient sedation levels for titration. Effective tourniquet placement may be used to separate a region of the body from general circulation, rendering distal tissues unaffected by neuromuscular blockade. ⋯ A 73-year-old white woman presented to the emergency department with a stroke, and her condition generalized into diffuse tonic-clonic seizures. Concern for airway integrity warranted intubation with appropriate induction of paralysis and sedation. A tourniquet was placed proximal to the right knee and tightened until a dorsalis pedis pulse was no longer palpable. Computed tomography and computed tomography angiography of the head revealed no cerebrovascular event. After imaging, purposeful movements were noted in the right lower extremity distal to the tourniquet despite the initiation of standard dose post-intubation sedation with fentanyl (0.5 μg/kg/h) and propofol (20 μg/kg/min). No tonic-clonic activity was observed. With necessary up-titration, movements ceased. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The observations made support the use of temporally limited tourniquet placement during paralytic administration to assess patient seizure status and sedation levels. Mindful tourniquet use in this manner permits a more effective sedation and management protocol for SE patients coming into the ED and may outweigh the minor risks associated with short-term hypoperfusion.
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Medication shortages commonly occur in resource-poor settings. The relatively short expiry dates on many medications exacerbate these shortages, often requiring clinicians to choose between providing needed medications to the patient and violating rules governing drug dispensing. ⋯ Ethically, physicians have a duty to place their patient's welfare above their own self-interest. In a time of increasing medication shortages around the globe, clinicians need to push rule makers to synchronize drug expiry dates with scientific findings.
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Observational Study
Prognostic Value of Serum Procalcitonin Levels in Patients With Febrile Neutropenia Presenting to the Emergency Department.
Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications. ⋯ PCT is a useful marker with better prognostic efficacy than MASCC score in patients with FN and can be used as an adjunct to the score in risk-stratifying patients with FN.