The American journal of emergency medicine
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The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While systemic inflammation and pulmonary complications can result in significant morbidity and mortality, cardiovascular complications may also occur. ⋯ Emergency clinicians should be aware of these cardiovascular complications when evaluating and managing the patient with COVID-19.
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Case Reports
COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection.
Recent retrospective studies from Wuhan, China suggest Novel Coronavirus Disease 2019 (COVID-19) may be associated with a hypercoagulable state and increased risk for venous thromboembolism. The overlap in the signs and symptoms of COVID-19 associated Acute Respiratory Distress Syndrome (ARDS) and COVID-19 with concurrent pulmonary embolism creates a diagnostic challenge for emergency medicine physicians in patients already at risk for renal impairment. ⋯ Hemoptysis is seen in roughly 13% of pulmonary embolism cases and infrequently reported among COVID-19 infections. Additionally, the presence of right heart strain on electrocardiography (EKG) is a well described clinical presentations of pulmonary embolism not reported commonly with COVID-19 infections.
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Comparative Study
Presentation and outcomes of end stage liver disease patients presenting with septic shock to the emergency department.
Patients with end stage liver disease (ESLD) are particularly vulnerable to sepsis. ESLD patients are often excluded from controlled sepsis trials and more data are needed to guide the management of this population. ⋯ Patients with ESLD comprise a small but important subgroup of patients with ED septic shock that experience high mortality compared to patients without ESLD. Maximum ED lactate and pneumonia as the source of sepsis are independently associated with adverse outcome and may be used for early recognition of high-risk ESLD sepsis patients.
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The increased number of emergency clinic patients causes the length of stay in the emergency department, low patient satisfaction and dismiss of real emergency patients. In this study, we aimed to determine the prediction levels of emergency clinicians according to working year on the outcome of the ambulance patients and outpatients presented to the emergency department (ED). ⋯ Experienced clinicians can make much more accurate prediction on length of stay and the prognosis of the emergency patients so crowded follow-up areas of the emergency room can be planned much more effectively.