Managing Severe Hypoxic Respiratory Failure in COVID-19.

Purpose Of Review: Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic.

Recent Findings: Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation.

Vaccine Hesitancy.

Purpose Of Review: The recent COVID-19 pandemic has caused over 800,000 deaths in the USA as of this writing. Remarkable, several effective vaccines have been developed within 1 year of the occurrence of the pandemic's outbreak in the USA.

Recent Findings: Although the vaccine has proven to be remarkably effective in preventing hospitalization and death, the number of unvaccinated persons in the USA who are eligible for the vaccine remains over 35%.

Recent Developments in Infectious Disease Chemotherapy: Review for Emergency Department Practitioners 2020.

Purpose Of Review: We discuss and review new antimicrobials for treatment of bacterial, viral, fungal, and parasitic infections with indications, contraindications, and side effects for each. We will also review new information and indications on older agents that are relevant to clinical practice. Many of them may be unfamiliar to Emergency Physicians given their newness and at times hospital restrictions on their use.

EMS Disease Exposure, Transmission, and Prevention: a Review Article.

Purpose Of Review: This article aims to review recent literature regarding the risks of disease exposure to pre-hospital providers and the patients they serve, as well as the challenges they face in minimizing transmission and exposure.

Recent Findings: Many studies continue to show poor compliance with consistent universal precautions, as well as proper hand hygiene. Vaccination rates are suboptimal despite attempts to encourage compliance.

A multifaceted quality improvement program improves endotracheal tube confirmation documentation in the emergency department.

Confirmation of endotracheal tube (ETT) position is an essential part of emergency department (ED) airway care. The study team evaluated the effect of a multifaceted quality improvement initiative on improving confirmation documentation rates. Rates of documentation of appropriate methods of ETT position confirmation were better for patients undergoing ETT placement in the study site ED than for those arriving already intubated (103/127 [81.

Emergency department experience with nonoral contrast computed tomography in the evaluation of patients for appendicitis.

Study Objectives: The American College of Radiology lists oral contrast as an institution-specific option in the evaluation of right lower quadrant pain. Previous literature indicates that an accurate assessment for appendicitis can be made by CT using IV contrast alone, with significant time savings from withholding oral contrast. Before 2010, the protocol for CT use in the evaluation of possible appendicitis or undifferentiated abdominal pain routinely included oral contrast.

Pseudoseizures in a preadolescent: does this case have a bite?

We report a preadolescent girl with acquired complete heart block most likely caused by viral myocarditis. The diagnosis was supported by endomyocardial biopsy and several immunohistological panels. A temporary pacemaker was used, and the child responded well to therapy with full recovery of cardiac conduction.

How well do emergency physicians document confirmation of endotracheal tube placement?

The authors' goal was to determine the rate at which emergency physicians document confirmation of endotracheal tube (ET) placement. The study was conducted in a 60 000-visit emergency department (ED) of an urban tertiary referral hospital. The authors' airway registry database was used to identify patients requiring airway management; 433 patients met study criteria, 281 (65%) were intubated in the ED, and 152 (35%) were intubated prior to arrival.

A case of renal artery thrombosis with renal infarction.

Renal artery thrombosis is a rare, but serious and often misdiagnosed, condition. Emergency physicians and other physicians need to consider this diagnosis in unexplained flank pain, especially in patients with risk factors for this disease. In this case report, the authors review a case of renal infarction caused by renal artery thrombosis in a patient with risk factors for thrombosis but no previous history of thromboembolism.

Airway registry: a performance improvement surveillance project of emergency department airway management.

The aim of this study was to determine if use of a standardized airway data collection sheet can survey airway management practices in an emergency department. Success rates and trends from the authors' facility have been benchmarked against the National Emergency Airway Registry (NEAR). This study included all patients requiring invasive airway management during a 21-month period (July 1, 2005, through March 31, 2007).

Platelet aspirin resistance in ED patients with suspected acute coronary syndrome.

Background: Platelet aspirin resistance is reported to be as high as 45%. The prevalence of emergency department (ED) platelet aspirin resistance in suspected acute coronary syndrome (ACS) is not described. Our purpose was to determine the prevalence of platelet aspirin resistance.

Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life.

A 31 year old woman presented with the worst headache of her life and was diagnosed with cerebral venous sinus thrombosis (CVST) by routine unenhanced computed tomography (CT) scan, subsequently confirmed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Awareness of this less common cause for acute neurological presentation in the Emergency setting is important; the imaging characteristics of CVST are reviewed.

Venous thromboembolism prophylaxis in hospitalized heart failure patients.

Background: Venous thromboembolism (VTE) is a concerning problem for hospitalized heart failure (HF) patients. Current recommendations are that all hospitalized New York Heart Association Class III or IV HF patients should receive VTE prophylaxis. Our purpose was to describe the rate of use and the characteristics of patients receiving VTE prophylaxis in the Acute Decompensated Heart Failure National Registry (ADHERE).

Diabetic muscle infarction: a rare complication of advanced diabetes mellitus.

Diabetic muscle infarction is a rare complication of diabetes mellitus first described in 1965. It typically arises in patients with long-standing diabetes mellitus who have complications of the disease, including nephropathy, retinopathy, and neuropathy. It typically presents with acute onset of thigh pain with an associated palpable tender mass.

Elevated serum cardiac markers predict coronary artery disease in patients with a history of heart failure who present with chest pain: insights from the i*trACS registry.

The significance of a history of heart failure (HF) in patients presenting with acute coronary syndromes and elevated cardiac markers is unclear. The authors performed an analysis of patients enrolled in the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS). Cardiac marker measurement and cardiac catheterization were performed in 1174 patients.

An overview of non-cardiac cocaine toxicity.

Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article.

Urine protein as a rapid screen for renal function in the ED: can it replace serum creatinine in selected patients?

Many radiology departments are unwilling to perform studies that require contrast administration to adult emergency department patients over the age of 35 without having a documented serum creatinine concentration of less than 2.0 mg/dl within a week of the study. Significant diagnostic delays may ensue waiting for this serum test.

Head injury: which patients need imaging? Which test is best?

Some patients with head injuries definitely need to undergo an imaging study--usually computed tomography (CT). Most, however, are in a category of "apparently mild" injury, and controversy continues about which of them need to undergo imaging studies to rule out intracranial injuries.

Variable diagnostic approach to suspected pulmonary embolism in the ED of a major academic tertiary care center.

The purpose of this study is to retrospectively examine the patterns of diagnostic modality utilization in the setting of suspected acute pulmonary embolism (PE) by physicians in the emergency department (ED) of a major academic tertiary care center. All patients (n=180) with a hospital discharge diagnosis of PE that were admitted through the ED during 1997 to 1999 were included. Overall test frequency and distribution, ancillary testing used when the initial ventilation-perfusion (V/Q) scan or spiral computed tomography (sCT) angiogram was nondiagnostic, concordance of V/Q and sCT, and sensitivities of D-dimer assays, arterial blood gas analysis, and deep venous imaging were assessed.