The American journal of emergency medicine
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There have been more than 178 million global cases of COVID-19, the disease caused by the SARS-CoV-2 virus, with more than 3.8 million deaths worldwide [1]. COVID-19 can present with a wide variety of symptoms, and one rare manifestation that has been reported in the literature is acute epiglottitis. To date, there have been two reported cases of acute epiglottitis in COVID-19 positive patients [2, 3]. We present a case of a 49-year-old male presenting to a community emergency department with the chief complaint of dysphagia and sore throat, confirmed as acute epiglottitis, in the presence of a positive rapid COVID-19 PCR test.
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The Mortality Probability Model (MPM) is used in research and quality improvement to adjust for severity of illness and can also inform triage decisions. However, a limitation for its automated use or application is that it includes the variable "intracranial mass effect" (IME), which requires human engagement with the electronic health record (EHR). We developed and tested a natural language processing (NLP) algorithm to identify IME from CT head reports. ⋯ NLP can accurately identify IME from free-text reports of head CTs in approximately 80% of records, adequate to allow automatic calculation of MPM based on EHR data for many applications.
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Time is a critical metric in the emergency department (ED) for acute ischemic stroke and thrombolytic therapy. National guidelines have emphasized tracking time from stroke onset to treatment and decreasing door to needle (DTN) time [1, 2]. Multidisciplinary teamwork is encouraged but, there is limited evidence demonstrating the value of the pharmacist on the stroke response team. The goal of this study is to compare DTN times in the ED with or without a pharmacist at bedside and examine the impact on subsequent patient outcomes. ⋯ Patients with an emergency medicine pharmacist as part of their stroke response team had significantly lower DTN times. A higher proportion of these cases met benchmark DTN times less than 45 min and 30 min. An emergency medicine pharmacist on a stroke response team has the potential to improve patient care.
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Calcium plays a vital key role in cardiac automatism and excitation-contraction coupling, with low serum levels associated with myocardial contractility compromise especially if myocardial sarcoplasmic reticulum is unable to maintain enough calcium content to initiate normal cardiac contraction. We present a 42-year-old woman with postsurgical untreated hypoparathyroidism and severe hypocalcaemia manifested as acute heart failure, without underlying known cardiac disease. ⋯ This rare case report highlights the importance of considering hypocalcaemia as a potentially reversible cause of severe cardiac dysfunction. Exclusion of hypocalcemia due to surgical hypoparathyroidism is mandatory in any individual with acute heart failure previously subjected to thyroidectomy.