The American journal of emergency medicine
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We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. ⋯ All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with "COVID-19 croup," SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.
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Case Reports
Malperfusion-associated transient monoplegia as an initial manifestation of aortic dissection.
Acute aortic dissection (AD) is a life-threatening emergency. The most common symptom of AD is chest pain, more frequently associated with Type-A AD per the Stanford classification, while Type-B AD is associated with back and abdominal pain. Conversely, monoplegia is an uncommon symptom of AD. ⋯ Monoplegia in type-B AD can develop due to spinal-cord or lumbosacral-plexus ischemia. Malperfusion, determined by the balance of the pressure in the false and true lumens and subsequent end-organ ischemia, may produce transient or persistent symptom patterns. Emergency physicians need to suspect AD when a patient presents with monoplegia or transient symptom patterns of unknown etiology.
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Some coronavirus disease 2019 (COVID-19) patients develop rapidly progressive acute respiratory distress syndrome and require veno-venous extracorporeal membrane oxygenation (V-V ECMO). A previous study recommended the transfer of ECMO patients to ECMO centers. However, because of the pandemic, a limited number of ECMO centers are available for patient transfer. ⋯ He was admitted to the intensive care unit of our hospital and received tocilizumab. He was discharged on hospital day 31 with no significant sequelae. In this case report, we discuss important factors for the safe and appropriate interhospital transportation of COVID-19 patients on ECMO as well as staff and patient safety during helicopter transportation.