Emergency medicine journal : EMJ
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Multicenter Study
Development and implementation of a COVID-19 near real-time traffic light system in an acute hospital setting.
Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. ⋯ Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.
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Previous studies have shown that individuals overestimate the success of cardiopulmonary resuscitation (CPR) while underestimating its morbidity. Although perceptions of CPR success affect medical care in the emergency department (ED), no ED-based studies have been done. ⋯ Consistent with prior studies, individuals overestimate the success rate of CPR. Healthcare experience does not appear to mitigate optimism about CPR, and individuals overwhelmingly want CPR for themselves. Though few had talked about CPR with a medical provider, most wanted to have informed decision-making conversations. Such discussions could help patients obtain a more realistic view of CPR outcomes.
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The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. ⋯ This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.
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A short-cut review of the available medical literature was carried out to establish the proportion of patients who self-report an allergy to penicillin have a true penicillin allergy. After abstract review, four papers were found to answer this clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that many adults who self-report a penicillin allergy are probably not allergic to penicillin antibiotics.
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The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. ⋯ CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.