The American journal of emergency medicine
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The COVID-19 pandemic poses significant challenges to patients with end-stage kidney disease who receive treatment in outpatient dialysis centers. These patients represent a fragile population that is at higher risk for both infection and transmission. ⋯ As the pandemic continues, dialysis facilities will have an increasing burden to provide safe and accessible dialysis, while also being able to direct patients to the ED for either emergent dialysis or COVID-19 treatment/testing. We reviewed opinions, recommendations and guidelines developed by professional organizations and dialysis facilities for the management of "patients under investigation" (PUIs) and COVID-19 positive patients that depend on whether the suspicion occurs while the patient is at home vs. at the dialysis center.
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Spontaneous pneumomediastinum is a rare complication of viral pneumonia. Here we report a case of a 52 year old male who presented with a spontaneous pneumomediastinum in COVID-19 pneumonia, followed by a severe course of disease. We discuss the pathophysiological mechanisms underlying this association as well as its possible clinical implications as a marker of disease severity in COVID-19.
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Comparative Study
Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study.
This study aimed to compare the therapeutic efficacy of dimenhydrinate and metoclopramide in patients with nausea and vertigo. ⋯ In conclusion, this prospective, double-blind, randomized study showed that both DMT and MTP have similar efficacy in reducing nausea and vertigo symptoms in the ED.
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During the recent CoVID-19 pandemic, airway management recommendations have been provided to decrease aerosolization and risk of viral spread to healthcare providers. High efficiency particulate air (HEPA) viral filters and adaptors are one way to decrease the risk of aerosolization during intubation. When placed proximal to the ventilator circuit, these viral filters and adaptors can create a significant amount of dead space, which in our smallest patients can significantly impact effective ventilation. We report a case of hypoventilation in a pediatric patient due to lack of provider team appreciation or ventilator sensing of additional dead space due to HEPA viral filter and adaptor.
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Multicenter Study
Antibiotic prescribing for adult bacteriuria and pyuria in community hospital emergency departments.
To describe emergency department (ED) antibiotic prescribing for urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) and to identify improvement opportunities. ⋯ Among reviewed patients, poor UTI prescribing in 16 EDs resulted in unnecessary antibiotic days and preventable readmissions. Key areas for improvement include non-treatment of ASB and shorter durations for cystitis.